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A two-stage DEA model to evaluate the efficiency of the Italian health system

  • De Nicola, Arianna
  • Gitto, Simone
  • Mancuso, Paolo

Over the past twenty years, important changes in the Italian health system have led to different approaches in organizing, delivering and financing health services throughout the regions of the country. This study aims to examine the impact these factors have had on efficiency. The methodology adopted is based on the developments in bootstrapping Data Envelopment Analysis (DEA). In particular, employing a two-stage procedure, we analyzed the impact that political interventions have produced on healthcare efficiency. The data, which were at the local health unit level for the period 2004-2005, were aggregated to the provincial level in order to take into account patient mobility. The study reveals that the organizational model adopted by the Lombardia region allows for the best results in healthcare efficiency. Second, administrative decentralization from the regional governments to local health units is a source of inefficiency. Third, adjusting the cost of delivering care, by taking into consideration regional health characteristics, improves efficiency. Finally, future policy interventions should make careful valuations of the impacts of patient mobility on healthcare efficiency.

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Paper provided by University Library of Munich, Germany in its series MPRA Paper with number 39126.

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Date of creation: Jun 2011
Date of revision:
Handle: RePEc:pra:mprapa:39126
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  1. Léopold Simar & Paul W. Wilson, 1998. "Sensitivity Analysis of Efficiency Scores: How to Bootstrap in Nonparametric Frontier Models," Management Science, INFORMS, vol. 44(1), pages 49-61, January.
  2. Ancarani, A. & Di Mauro, C. & Giammanco, M.D., 2009. "The impact of managerial and organizational aspects on hospital wards' efficiency: Evidence from a case study," European Journal of Operational Research, Elsevier, vol. 194(1), pages 280-293, April.
  3. Gian Paolo Barbetta & Gilberto Turati & Angelo M. Zago, 2007. "Behavioral differences between public and private not-for-profit hospitals in the Italian national health service," Health Economics, John Wiley & Sons, Ltd., vol. 16(1), pages 75-96.
  4. Ferrario, Caterina & Zanardi, Alberto, 2011. "Fiscal decentralization in the Italian NHS: What happens to interregional redistribution?," Health Policy, Elsevier, vol. 100(1), pages 71-80, April.
  5. Matthias Staat, 2006. "Efficiency of hospitals in Germany: a DEA-bootstrap approach," Applied Economics, Taylor & Francis Journals, vol. 38(19), pages 2255-2263.
  6. Rosella Levaggi & Roberto Zanola, 2004. "Patients' migration across regions: the case of Italy," Applied Economics, Taylor & Francis Journals, vol. 36(16), pages 1751-1757.
  7. Léopold Simar & Paul Wilson, 2000. "Statistical Inference in Nonparametric Frontier Models: The State of the Art," Journal of Productivity Analysis, Springer, vol. 13(1), pages 49-78, January.
  8. Simar, Leopold & Zelenyuk, Valentin, 2004. "On testing equality of distributions of technical efficiency scores," MPRA Paper 28003, University Library of Munich, Germany.
  9. Silvio Daidone & Francesco D’Amico, 2009. "Technical efficiency, specialization and ownership form: evidences from a pooling of Italian hospitals," Journal of Productivity Analysis, Springer, vol. 32(3), pages 203-216, December.
  10. Giovanni Fattore & Aleksandra Torbica, 2006. "Inpatient reimbursement system in Italy: How do tariffs relate to costs?," Health Care Management Science, Springer, vol. 9(3), pages 251-258, August.
  11. Luigi Siciliani, 2006. "Estimating Technical Efficiency in the Hospital Sector with Panel Data: A Comparison of Parametric and Non-Parametric Techniques," Applied Health Economics and Health Policy, Springer Healthcare | Adis, vol. 5(2), pages 99-116.
  12. Valentin Zelenyuk, 2009. "Power of significance test of dummy variables in two-stage efficiency analysis model," Applied Economics Letters, Taylor & Francis Journals, vol. 16(15), pages 1493-1495.
  13. Halkos, George E. & Tzeremes, Nickolaos G., 2011. "A conditional nonparametric analysis for measuring the efficiency of regional public healthcare delivery: An application to Greek prefectures," Health Policy, Elsevier, vol. 103(1), pages 73-82.
  14. Simar, Leopold & Wilson, Paul W., 2007. "Estimation and inference in two-stage, semi-parametric models of production processes," Journal of Econometrics, Elsevier, vol. 136(1), pages 31-64, January.
  15. repec:ver:wpaper:12 is not listed on IDEAS
  16. Gary Ferrier & Michael Rosko & Vivian Valdmanis, 2006. "Analysis of uncompensated hospital care using a DEA model of output congestion," Health Care Management Science, Springer, vol. 9(2), pages 181-188, May.
  17. Grosskopf, Shawna & Margaritis, Dimitri & Valdmanis, Vivian, 2004. "Competitive effects on teaching hospitals," European Journal of Operational Research, Elsevier, vol. 154(2), pages 515-525, April.
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