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Death by austerity? The impact of cost containment on avoidable mortality in Italy

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  • Emanuele Arcà
  • Francesco Principe
  • Eddy Van Doorslaer

Abstract

Does austerity in health care affect health and healthcare outcomes? We examine the intended and unintended effects of the Italian austerity policy Piano di Rientro aimed at containing the cost of the healthcare sector. Using an instrumental variable strategy that exploits the temporal and geographical variation induced by the policy rollout, we find that the policy was successful in alleviating deficits by reducing expenditure, mainly in the southern regions, but also resulted in a 3% rise in avoidable deaths among both men and women, a reduction in hospital capacity and a rise in south‐to‐north patient migration. These findings suggest that—even in a high‐income country with relatively low avoidable mortality like Italy—spending cuts can hurt survival.

Suggested Citation

  • Emanuele Arcà & Francesco Principe & Eddy Van Doorslaer, 2020. "Death by austerity? The impact of cost containment on avoidable mortality in Italy," Health Economics, John Wiley & Sons, Ltd., vol. 29(12), pages 1500-1516, December.
  • Handle: RePEc:wly:hlthec:v:29:y:2020:i:12:p:1500-1516
    DOI: 10.1002/hec.4147
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    1. Karl Claxton & James Lomas & Stephen Martin, 2018. "The impact of NHS expenditure on health outcomes in England: Alternative approaches to identification in all‐cause and disease specific models of mortality," Health Economics, John Wiley & Sons, Ltd., vol. 27(6), pages 1017-1023, June.
    2. Parida Wubulihasimu & Werner Brouwer & Pieter van Baal, 2016. "The Impact of Hospital Payment Schemes on Healthcare and Mortality: Evidence from Hospital Payment Reforms in OECD Countries," Health Economics, John Wiley & Sons, Ltd., vol. 25(8), pages 1005-1019, August.
    3. Martyn Andrews & Obbey Elamin & Alastair R. Hall & Kostas Kyriakoulis & Matthew Sutton, 2017. "Inference in the presence of redundant moment conditions and the impact of government health expenditure on health outcomes in England," Econometric Reviews, Taylor & Francis Journals, vol. 36(1-3), pages 23-41, March.
    4. Martin, Stephen & Rice, Nigel & Smith, Peter C., 2008. "Does health care spending improve health outcomes? Evidence from English programme budgeting data," Journal of Health Economics, Elsevier, vol. 27(4), pages 826-842, July.
    5. Edney, L.C. & Haji Ali Afzali, H. & Cheng, T.C. & Karnon, J., 2018. "Mortality reductions from marginal increases in public spending on health," Health Policy, Elsevier, vol. 122(8), pages 892-899.
    6. Moreno-Serra, Rodrigo & Wagstaff, Adam, 2010. "System-wide impacts of hospital payment reforms: Evidence from Central and Eastern Europe and Central Asia," Journal of Health Economics, Elsevier, vol. 29(4), pages 585-602, July.
    7. James Lomas & Stephen Martin & Karl Claxton, 2018. "Estimating the marginal productivity of the English National Health Service from 2003/04 to 2012/13," Working Papers 158cherp, Centre for Health Economics, University of York.
    8. Ryota Nakamura & James Lomas & Karl Claxton & Farasat Bokhari & Rodrigo Moreno-Serra & Marc Suhrcke & Peter Berman, 2020. "Assessing the Impact of Health Care Expenditures on Mortality Using Cross-Country Data," World Scientific Book Chapters, in: Paul Revill & Marc Suhrcke & Rodrigo Moreno-Serra & Mark Sculpher (ed.), Global Health Economics Shaping Health Policy in Low- and Middle-Income Countries, chapter 1, pages 3-49, World Scientific Publishing Co. Pte. Ltd..
    9. Pierre‐Yves Crémieux & Pierre Ouellette & Caroline Pilon, 1999. "Health care spending as determinants of health outcomes," Health Economics, John Wiley & Sons, Ltd., vol. 8(7), pages 627-639, November.
    10. Douglas Staiger & James H. Stock, 1997. "Instrumental Variables Regression with Weak Instruments," Econometrica, Econometric Society, vol. 65(3), pages 557-586, May.
    11. Hitiris, Theo & Posnett, John, 1992. "The determinants and effects of health expenditure in developed countries," Journal of Health Economics, Elsevier, vol. 11(2), pages 173-181, August.
    12. Depalo, Domenico, 2019. "The side effects on health of a recovery plan in Italy: A nonparametric bounding approach," Regional Science and Urban Economics, Elsevier, vol. 78(C).
    13. Gallet, Craig A. & Doucouliagos, Hristos, 2017. "The impact of healthcare spending on health outcomes: A meta-regression analysis," Social Science & Medicine, Elsevier, vol. 179(C), pages 9-17.
    14. Stephen Martin & Nigel Rice & Peter C. Smith, 2012. "Comparing costs and outcomes across programmes of health care," Health Economics, John Wiley & Sons, Ltd., vol. 21(3), pages 316-337, March.
    15. Farasat A. S. Bokhari & Yunwei Gai & Pablo Gottret, 2007. "Government health expenditures and health outcomes," Health Economics, John Wiley & Sons, Ltd., vol. 16(3), pages 257-273, March.
    16. John Nixon & Philippe Ulmann, 2006. "The relationship between health care expenditure and health outcomes," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 7(1), pages 7-18, March.
    17. Cristina Borra & Jerònia Pons-Pons & Margarita Vilar-Rodríguez, 2020. "Austerity, healthcare provision, and health outcomes in Spain," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(3), pages 409-423, April.
    18. Di Novi, Cinzia & Piacenza, Massimiliano & Robone, Silvana & Turati, Gilberto, 2019. "Does fiscal decentralization affect regional disparities in health? Quasi-experimental evidence from Italy," Regional Science and Urban Economics, Elsevier, vol. 78(C).
    19. Rodrigo Moreno-Serra & Peter C. Smith, 2015. "Broader health coverage is good for the nation's health: evidence from country level panel data," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 178(1), pages 101-124, January.
    20. Davide Golinelli & Fabrizio Toscano & Andrea Bucci & Jacopo Lenzi & Maria Pia Fantini & Nicola Nante & Gabriele Messina, 2017. "Health Expenditure and All-Cause Mortality in the ‘Galaxy’ of Italian Regional Healthcare Systems: A 15-Year Panel Data Analysis," Applied Health Economics and Health Policy, Springer, vol. 15(6), pages 773-783, December.
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    1. Chris Sampson’s journal round-up for 7th December 2020
      by Chris Sampson in The Academic Health Economists' Blog on 2020-12-07 12:00:03

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