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The dark side of fiscal federalism:evidence from hospital care in Italy

Author

Listed:
  • Paolo Berta

    (Università di Milano Bicocca)

  • Carla Guerriero

    (Università di Napoli Federico II)

  • Rosella Levaggi

    (Università di Brescia)

Abstract

We use 2009-14 data from patients hospital discharges to assess the effects of fiscal federalism on the quality of care provided to regional and extraregional patients in Lombardy. Empirical results suggest that even after controlling for hospital fixed effects, patients demographic and health characteristics, extraregional patients wait less compared to regional ones, stay longer in hospital and are associated with higher reimbursement costs. However, private and public hospitals with higher proportion of extraregional patients show a lower mortality and lower reimbursement costs. This result suggest that competition works because of the spillovers effects that the market for extraregional patients produces.

Suggested Citation

  • Paolo Berta & Carla Guerriero & Rosella Levaggi, 2018. "The dark side of fiscal federalism:evidence from hospital care in Italy," Working papers 72, Società Italiana di Economia Pubblica.
    • Handle: RePEc:ipu:wpaper:72
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    More about this item

    Keywords

    Hospital competition; patients mobility; mixed market; fiscal federalism;
    All these keywords.

    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • H77 - Public Economics - - State and Local Government; Intergovernmental Relations - - - Intergovernmental Relations; Federalism
    • D6 - Microeconomics - - Welfare Economics
    • C70 - Mathematical and Quantitative Methods - - Game Theory and Bargaining Theory - - - General

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