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Quality and health care performance in the Italian regions


  • De Nicola, Arianna
  • Mancuso, Paolo
  • Valdmanis, Vivian


This paper estimates the total factor productivity of the Italian health care sector using a modified bootstrapped Malmquist Index including the quality of the production process provided to the population. Decomposing the productivity process in three different components (efficiency change, technological change and quality change) we can detemine if the increasing/decreasing health care productivity of the 20 Italian regions is strictly related to any of the changes during 1999-2008. The results highlights also significant difference in the terms of North-South divide.

Suggested Citation

  • De Nicola, Arianna & Mancuso, Paolo & Valdmanis, Vivian, 2013. "Quality and health care performance in the Italian regions," MPRA Paper 50495, University Library of Munich, Germany.
  • Handle: RePEc:pra:mprapa:50495

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    References listed on IDEAS

    1. 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.
    2. Leleu, Hervé & Moises, James & Valdmanis, Vivian, 2012. "Optimal productive size of hospital's intensive care units," International Journal of Production Economics, Elsevier, vol. 136(2), pages 297-305.
    3. Rosella Levaggi & Roberto Zanola, 2004. "Patients' migration across regions: the case of Italy," Applied Economics, Taylor & Francis Journals, vol. 36(16), pages 1751-1757.
    4. Simar, Leopold & Wilson, Paul W., 1999. "Estimating and bootstrapping Malmquist indices," European Journal of Operational Research, Elsevier, vol. 115(3), pages 459-471, June.
    5. Pica, Federico & Villani, Salvatore, 2010. "Questioni concernenti la nozione di costo standard: la mobilità dei pazienti e le mode sanitarie
      [Issues regarding the standard cost notion: patients’ interregional mobility and «health fashions»]
      ," MPRA Paper 29659, University Library of Munich, Germany.
    6. Maffezzoli Marco, 2006. "Convergence Across Italian Regions and the Role of Technological Catch-Up," The B.E. Journal of Macroeconomics, De Gruyter, vol. 6(1), pages 1-43, August.
    7. Fare, R. & Grosskopf, S. & Roos, P., 1995. "Productivity and quality changes in Swedish pharmacies," International Journal of Production Economics, Elsevier, vol. 39(1-2), pages 137-144, April.
    8. Anatoly I. Pilyavsky & William E. Aaronson & Patrick M. Bernet & Michael D. Rosko & Vivian G. Valdmanis & Mikhail V. Golubchikov, 2006. "East-west: does it make a difference to hospital efficiencies in Ukraine?," Health Economics, John Wiley & Sons, Ltd., vol. 15(11), pages 1173-1186.
    9. Caves, Douglas W & Christensen, Laurits R & Diewert, W Erwin, 1982. "The Economic Theory of Index Numbers and the Measurement of Input, Output, and Productivity," Econometrica, Econometric Society, vol. 50(6), pages 1393-1414, November.
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    Cited by:

    1. Karmann, Alexander & Roesel, Felix, 2016. "Hospital policy and productivity: Evidence from German states," CEPIE Working Papers 07/16, Technische Universität Dresden, Center of Public and International Economics (CEPIE).

    More about this item


    Malmquist; quality; DEA; health care; regional differences; Italy.;

    JEL classification:

    • D24 - Microeconomics - - Production and Organizations - - - Production; Cost; Capital; Capital, Total Factor, and Multifactor Productivity; Capacity
    • I1 - Health, Education, and Welfare - - Health
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior

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