IDEAS home Printed from https://ideas.repec.org/p/ctc/serie1/def103.html
   My bibliography  Save this paper

Does prescribing appropriateness reduce health expenditures? Main effects and unintended outcomes

Author

Listed:
  • Claudio Lucifora

    (Università Cattolica del Sacro Cuore
    Dipartimento di Economia e Finanza, Università Cattolica del Sacro Cuore)

  • Antonio Russo
  • Daria Vigani

    (Università Cattolica del Sacro Cuore
    Dipartimento di Economia e Finanza, Università Cattolica del Sacro Cuore)

Abstract

We evaluate the effectiveness of a reform to contain health-care costs by restraining general practitioners' (GP) ability to prescribe outpatient treatments, on the basis of strict appropriateness criteria. Using register data for a large Metropolitan area in Italy, we find a significant contraction in both outpatient expenditures (-24%) and volumes (-12%) after the reform. The effects on expenditures are found to be heterogeneous across GPs' characteristics, pointing out the mediating role of GPs' prescribing behavior. The reform also affected the composition of outpatient spending and produced unintended consequences on the demand for medical services of vulnerable groups, who were originally excluded from its application, as well as on access to emergency care.

Suggested Citation

  • Claudio Lucifora & Antonio Russo & Daria Vigani, 2021. "Does prescribing appropriateness reduce health expenditures? Main effects and unintended outcomes," DISCE - Working Papers del Dipartimento di Economia e Finanza def103, Università Cattolica del Sacro Cuore, Dipartimenti e Istituti di Scienze Economiche (DISCE).
    • Handle: RePEc:ctc:serie1:def103
    as

    Download full text from publisher

    File URL: http://dipartimenti.unicatt.it/economia-finanza-def103.pdf
    File Function: First version, 2021
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Schreyögg, Jonas & Grabka, Markus M., 2010. "Copayments for Ambulatory Care in Germany: A Natural Experiment Using a Difference-in-Difference Approach," EconStor Open Access Articles and Book Chapters, ZBW - Leibniz Information Centre for Economics, vol. 11(3), pages 331-341.
    2. Government of India, 2017. "National Health Policy 2017," Working Papers id:11664, eSocialSciences.
    3. David Cutler & Jonathan S. Skinner & Ariel Dora Stern & David Wennberg, 2019. "Physician Beliefs and Patient Preferences: A New Look at Regional Variation in Health Care Spending," American Economic Journal: Economic Policy, American Economic Association, vol. 11(1), pages 192-221, February.
    4. Nicolas Ziebarth, 2014. "Assessing the effectiveness of health care cost containment measures: evidence from the market for rehabilitation care," International Journal of Health Economics and Management, Springer, vol. 14(1), pages 41-67, March.
    5. van Kleef, R.C. & van de Ven, W.P.M.M. & van Vliet, R.C.J.A., 2009. "Shifted deductibles for high risks: More effective in reducing moral hazard than traditional deductibles," Journal of Health Economics, Elsevier, vol. 28(1), pages 198-209, January.
    6. Buetow, Stephen A. & Sibbald, Bonnie & Cantrill, Judith A. & Halliwell, Shirley, 1997. "Appropriateness in health care: Application to prescribing," Social Science & Medicine, Elsevier, vol. 45(2), pages 261-271, July.
    7. Fiorentini, Gianluca & Lippi Bruni, Matteo & Ugolini, Cristina, 2013. "GPs and hospital expenditures. Should we keep expenditure containment programs alive?," Social Science & Medicine, Elsevier, vol. 82(C), pages 10-20.
    8. David H. Autor, 2003. "Outsourcing at Will: The Contribution of Unjust Dismissal Doctrine to the Growth of Employment Outsourcing," Journal of Labor Economics, University of Chicago Press, vol. 21(1), pages 1-42, January.
    9. Katherine Baicker & Dana Goldman, 2011. "Patient Cost-Sharing and Healthcare Spending Growth," Journal of Economic Perspectives, American Economic Association, vol. 25(2), pages 47-68, Spring.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Chiara Punzo & Giulia Rivolta, 2022. "Money versus debt financed regime: Evidence from an estimated DSGE model," DISCE - Working Papers del Dipartimento di Economia e Finanza def120, Università Cattolica del Sacro Cuore, Dipartimenti e Istituti di Scienze Economiche (DISCE).
    2. Boitani, Andrea & Dragomirescu-Gaina, Catalin, 2023. "News and narratives: A cointegration analysis of Russian economic policy uncertainty," Economics Letters, Elsevier, vol. 226(C).
    3. Valentina Colombo & Alessia Paccagnini, 2024. "Uncertainty and the Federal Reserve’s Balance Sheet Monetary Policy," DISCE - Working Papers del Dipartimento di Economia e Finanza def131, Università Cattolica del Sacro Cuore, Dipartimenti e Istituti di Scienze Economiche (DISCE).
    4. Basiglio, Stefania & Foresta, Alessandra & Turati, Gilberto, 2024. "Impatience and crime. Evidence from the NLSY97," Journal of Economic Psychology, Elsevier, vol. 101(C).
    5. Daniele Checchi & Alessandra Fenizia & Claudio Lucifora, 2021. "PUBLIC SECTOR JOBS: Working in the public sector in Europe and the US," DISCE - Working Papers del Dipartimento di Economia e Finanza def107, Università Cattolica del Sacro Cuore, Dipartimenti e Istituti di Scienze Economiche (DISCE).
    6. Russell Davidson & Andrea Monticini, 2023. "Bootstrap Performance with Heteroskedasticity," DISCE - Working Papers del Dipartimento di Economia e Finanza def130, Università Cattolica del Sacro Cuore, Dipartimenti e Istituti di Scienze Economiche (DISCE).
    7. Luca Armanaschi & Elisabetta Barzan & Magda Cavallucci & Carlo Federici & Marco Sartirana & Florian Zerzer, 2022. "I dati amministrativi per la governance dei tempi di attesa delle prestazioni ambulatoriali: l?esperienza dell?Azienda Sanitaria dell?Alto Adige," MECOSAN, FrancoAngeli Editore, vol. 2022(123), pages 53-75.
    8. Irene Torrini & Claudio Lucifora & Antonio Russo, 2022. "The Long-Term Effects of Hospitalization on Health Care Expenditures: An Empirical Analysis for the Young-Old Population," DISCE - Working Papers del Dipartimento di Economia e Finanza def117, Università Cattolica del Sacro Cuore, Dipartimenti e Istituti di Scienze Economiche (DISCE).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Nicolas Ziebarth, 2014. "Assessing the effectiveness of health care cost containment measures: evidence from the market for rehabilitation care," International Journal of Health Economics and Management, Springer, vol. 14(1), pages 41-67, March.
    2. Ya-Ling Lin & Wen-Yi Chen & Shwn-Huey Shieh, 2020. "Age Structural Transitions and Copayment Policy Effectiveness: Evidence from Taiwan’s National Health Insurance System," IJERPH, MDPI, vol. 17(12), pages 1-17, June.
    3. Kyle, Margaret K., 2022. "Incentives for pharmaceutical innovation: What’s working, what’s lacking," International Journal of Industrial Organization, Elsevier, vol. 84(C).
    4. Yuji Mizushima & Haruko Noguchi, 2021. "Spillover effects of minimum wages on suicide mortality: Evidence from Japan," Working Papers 2105, Waseda University, Faculty of Political Science and Economics.
    5. D. Cattel & R. C. Kleef & R. C. J. A. Vliet, 2017. "A method to simulate incentives for cost containment under various cost sharing designs: an application to a first-euro deductible and a doughnut hole," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 18(8), pages 987-1000, November.
    6. Yoseph, Nir Shlomo, 2018. "The Impact of Environmental Fraud on the Used Car Market: Evidence from Dieselgate," CEPR Discussion Papers 12899, C.E.P.R. Discussion Papers.
    7. Beestermöller, Matthias, 2017. "Striking Evidence? Demand Persistence for Inter-City Buses from German Railway Strikes," Discussion Papers in Economics 31768, University of Munich, Department of Economics.
    8. Muñoz-Acevedo, Ángela & Grzybowski, Lukasz, 2023. "Impact of roaming regulation on revenues and prices of mobile operators in the EU," International Journal of Industrial Organization, Elsevier, vol. 89(C).
    9. Picarelli, Nathalie, 2016. "Who really benefits from export processing zones? Evidence from Nicaraguan municipalities," Labour Economics, Elsevier, vol. 41(C), pages 318-332.
    10. Tajul Masron & Mduduzi Biyase & Talent Zwane & Thomas Udimal & Frederich Kirsten, 2023. "Ecological footprint and population health outcomes: an analysis of E7 countries," Economics Working Papers edwrg-07-2023, College of Business and Economics, University of Johannesburg, South Africa, revised 2023.
    11. Uribe-Castro, Mateo, 2019. "Expropriation of church wealth and political conflict in 19th century Colombia," Explorations in Economic History, Elsevier, vol. 73(C), pages 1-1.
    12. Nikolov, Plamen & Adelman, Alan, 2019. "Do private household transfers to the elderly respond to public pension benefits? Evidence from rural China," The Journal of the Economics of Ageing, Elsevier, vol. 14(C).
    13. Dhammika Dharmapala & Richard H. McAdams & John Rappaport, 2019. "Collective Bargaining and Police Misconduct: Evidence from Florida," CESifo Working Paper Series 7718, CESifo.
    14. Bubeck, Johannes & Maddaloni, Angela & Peydró, José-Luis, 2020. "Negative Monetary Policy Rates and Systemic Banks' Risk‐Taking: Evidence from the Euro Area Securities Register," EconStor Open Access Articles and Book Chapters, ZBW - Leibniz Information Centre for Economics, vol. 52(S1), pages 197-231.
    15. Pham, Tho & Talavera, Oleksandr & Tsapin, Andriy, 2018. "Shock contagion, asset quality and lending behavior," BOFIT Discussion Papers 21/2018, Bank of Finland Institute for Emerging Economies (BOFIT).
    16. Xin Zhao & Xiaoxue Li & Benno Torgler & Uwe Dulleck, 2021. "Patient violence, physicians treatment decisions, and patient welfare: Evidence from China," Health Economics, John Wiley & Sons, Ltd., vol. 30(6), pages 1461-1479, June.
    17. Shawhan, Daniel L. & Picciano, Paul D., 2019. "Costs and benefits of saving unprofitable generators: A simulation case study for US coal and nuclear power plants," Energy Policy, Elsevier, vol. 124(C), pages 383-400.
    18. Toro, Weily & Tigre, Robson & Sampaio, Breno, 2015. "Daylight Saving Time and incidence of myocardial infarction: Evidence from a regression discontinuity design," Economics Letters, Elsevier, vol. 136(C), pages 1-4.
    19. Anand Acharya & Lynda Khalaf & Marcel Voia & Myra Yazbeck & David Wensley, 2021. "Severity of Illness and the Duration of Intensive Care," Working Papers 2021-003, Human Capital and Economic Opportunity Working Group.
    20. Zhang, Zibin & Yang, Wenxin & Ye, Jianliang, 2021. "Why sulfur dioxide emissions decline significantly from coal-fired power plants in China? Evidence from the desulfurated electricity pricing premium program," Energy Policy, Elsevier, vol. 148(PB).

    More about this item

    Keywords

    Prescribing appropriateness; Health-care expenditures; Primary care.;
    All these keywords.

    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I38 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - Government Programs; Provision and Effects of Welfare Programs
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:ctc:serie1:def103. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Simone Moriconi (email available below). General contact details of provider: https://edirc.repec.org/data/dscatit.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.