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Potential efficiency gains and expenditure savings in the Italian Regional Healthcare Systems

Author

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  • Dino Rizzi

    (Department of Economics, University Of Venice CÃ Foscari)

  • Michele Zanette

    (Department of Economics, University Of Venice CÃ Foscari)

Abstract

The paper aims to analyse the extent to which the adoption of best practice policies could improve the efficiency of Italian Regional Healthcare Systems (RHSs) and reduce public healthcare expenditures. By means of a stochastic frontier model we estimate the RHSs’ technical inefficiency and its determinants using a panel data of 16 regions over the period 2010-2016. We use the Essential Levels of Care (LEA) scores computed by the Ministry of Health as a proxy for the RHSs’ output and public healthcare expenditure as the main input. The level of inefficiency is a function of a set of variables summarising the organisational arrangements implemented by RHS policymakers. The results allow us to identify the best-practice policy, defined as the set of observable organisational arrangements that maximises aggregate efficiency. Adoption of the best-practice policy by all RHSs leads to potential efficiency gains of 1.5 per cent on average (from 93.4 per cent to 94.9 per cent) and to potential healthcare expenditure savings of 1.8 billion euro in 2016 (1.77 per cent of current expenditures).

Suggested Citation

  • Dino Rizzi & Michele Zanette, 2021. "Potential efficiency gains and expenditure savings in the Italian Regional Healthcare Systems," Working Papers 2021:27, Department of Economics, University of Venice "Ca' Foscari".
  • Handle: RePEc:ven:wpaper:2021:27
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    as
    1. Sharon Hadad & Yossi Hadad & Tzahit Simon-Tuval, 2013. "Determinants of healthcare system’s efficiency in OECD countries," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(2), pages 253-265, April.
    2. João Medeiros & Christoph Schwierz, 2015. "Efficiency estimates of health care systems," European Economy - Economic Papers 2008 - 2015 549, Directorate General Economic and Financial Affairs (DG ECFIN), European Commission.
    3. Pablo Cos & Enrique Moral-Benito, 2014. "Determinants of health-system efficiency: evidence from OECD countries," International Journal of Health Economics and Management, Springer, vol. 14(1), pages 69-93, March.
    4. Bonasia, Mariangela & Kounetas, Konstantinos & Oreste, Napolitano, 2020. "Assessment of regional productive performance of European health systems under a metatechnology framework," Economic Modelling, Elsevier, vol. 84(C), pages 234-248.
    5. Isabelle Joumard & Christophe André & Chantal Nicq, 2010. "Health Care Systems: Efficiency and Institutions," OECD Economics Department Working Papers 769, OECD Publishing.
    6. Bruce Hollingsworth & John Wildman, 2003. "The efficiency of health production: re‐estimating the WHO panel data using parametric and non‐parametric approaches to provide additional information," Health Economics, John Wiley & Sons, Ltd., vol. 12(6), pages 493-504, June.
    7. Asandului, Laura & Roman, Monica & Fatulescu, Puiu, 2013. "The Efficiency of Healthcare Systems in Europe: a Data Envelopment Analysis Approach," MPRA Paper 58954, University Library of Munich, Germany, revised Apr 2014.
    8. William Greene, 2004. "Distinguishing between heterogeneity and inefficiency: stochastic frontier analysis of the World Health Organization's panel data on national health care systems," Health Economics, John Wiley & Sons, Ltd., vol. 13(10), pages 959-980, October.
    9. Richard Gearhart, 2016. "No theory: an explanation of the lack of consistency in cross-country health care comparisons using non-parametric estimators," Health Economics Review, Springer, vol. 6(1), pages 1-12, December.
    10. Jaume Puig‐Junoy & Vicente Ortún, 2004. "Cost efficiency in primary care contracting: a stochastic frontier cost function approach," Health Economics, John Wiley & Sons, Ltd., vol. 13(12), pages 1149-1165, December.
    11. Hung-jen Wang & Peter Schmidt, 2002. "One-Step and Two-Step Estimation of the Effects of Exogenous Variables on Technical Efficiency Levels," Journal of Productivity Analysis, Springer, vol. 18(2), pages 129-144, September.
    12. 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, January.
    13. Vinish Kathuria & Deepa Sankar, 2005. "Inter-State Disparities in Health Outcomes in Rural India: An Analysis Using a Stochastic Production Frontier Approach," Development Policy Review, Overseas Development Institute, vol. 23(2), pages 145-163, March.
    14. Allin, Sara & Grignon, Michel & Wang, Li, 2016. "The determinants of efficiency in the Canadian health care system," Health Economics, Policy and Law, Cambridge University Press, vol. 11(1), pages 39-65, January.
    15. Wranik, Dominika, 2012. "Healthcare policy tools as determinants of health-system efficiency: evidence from the OECD," Health Economics, Policy and Law, Cambridge University Press, vol. 7(2), pages 197-226, April.
    16. Diewert, W E, 1974. "Functional Forms for Revenue and Factor Requirements Functions," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 15(1), pages 119-130, February.
    17. Roberto Colombi & Gianmaria Martini & Giorgio Vittadini, 2017. "Determinants of transient and persistent hospital efficiency: The case of Italy," Health Economics, John Wiley & Sons, Ltd., vol. 26(S2), pages 5-22, September.
    18. Nan Jiang & Antony Andrews, 2020. "Efficiency of New Zealand’s District Health Boards at Providing Hospital Services: A stochastic frontier analysis," Journal of Productivity Analysis, Springer, vol. 53(1), pages 53-68, February.
    19. Cinzia Di Novi & Dino Rizzi & Michele Zanette, 2018. "Scale Effects and Expected Savings from Consolidation Policies of Italian Local Healthcare Authorities," Applied Health Economics and Health Policy, Springer, vol. 16(1), pages 107-122, February.
    20. Raffaele Lagravinese & Paolo Liberati & Giuliano Resce, 2017. "Exploring health outcomes by stochastic multi-objective acceptability analysis: an application to Italian regions," Working Papers. Collection B: Regional and sectoral economics 1703, Universidade de Vigo, GEN - Governance and Economics research Network.
    21. Camilla Mastromarco & Lenka Stastna & Jana Votapkova, 2019. "Efficiency of hospitals in the Czech Republic: Conditional efficiency approach," Journal of Productivity Analysis, Springer, vol. 51(1), pages 73-89, February.
    22. Yohannes Kinfu, 2013. "The efficiency of the health system in South Africa: evidence from stochastic frontier analysis," Applied Economics, Taylor & Francis Journals, vol. 45(8), pages 1003-1010, March.
    23. 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.
    24. Kodde, David A & Palm, Franz C, 1986. "Wald Criteria for Jointly Testing Equality and Inequality Restriction s," Econometrica, Econometric Society, vol. 54(5), pages 1243-1248, September.
    25. Chowdhury, Hedayet & Zelenyuk, Valentin, 2016. "Performance of hospital services in Ontario: DEA with truncated regression approach," Omega, Elsevier, vol. 63(C), pages 111-122.
    26. Chiara Canta & Massimiliano Piacenza & Turati Gilberto, 2005. "Riforme del Servizio Sanitario Nazionale e dinamica dell’efficienza ospedaliera in Piemonte," CERIS Working Paper 200515, Institute for Economic Research on Firms and Growth - Moncalieri (TO) ITALY -NOW- Research Institute on Sustainable Economic Growth - Moncalieri (TO) ITALY.
    27. Battese, G E & Coelli, T J, 1995. "A Model for Technical Inefficiency Effects in a Stochastic Frontier Production Function for Panel Data," Empirical Economics, Springer, vol. 20(2), pages 325-332.
    28. N. Maniadakis & N. Kotsopoulos & P. Prezerakos & J. Yfantopoulos, 2009. "Health Care Services Performance Measurement: Theory, Methods and Empirical Evidence," European Research Studies Journal, European Research Studies Journal, vol. 0(3), pages 151-170.
    29. Felder, Stefan & Tauchmann, Harald, 2013. "Federal state differentials in the efficiency of health production in Germany: an artifact of spatial dependence?," EconStor Open Access Articles and Book Chapters, ZBW - Leibniz Information Centre for Economics, pages 21-39.
    30. Häkkinen, Unto & Iversen, Tor & Peltola, Mikko & Seppälä, Timo T. & Malmivaara, Antti & Belicza, Éva & Fattore, Giovanni & Numerato, Dino & Heijink, Richard & Medin, Emma & Rehnberg, Clas, 2013. "Health care performance comparison using a disease-based approach: The EuroHOPE project," Health Policy, Elsevier, vol. 112(1), pages 100-109.
    31. Bruce Hollingsworth, 2008. "The measurement of efficiency and productivity of health care delivery," Health Economics, John Wiley & Sons, Ltd., vol. 17(10), pages 1107-1128, October.
    32. OGLOBLIN, Constantin, 2011. "Health Care Efficiency Across Countries: A Stochastic Frontier Analysis," Applied Econometrics and International Development, Euro-American Association of Economic Development, vol. 11(1).
    33. Kankana Mukherjee & Rexford Santerre & Ning Jackie Zhang, 2010. "Explaining the efficiency of local health departments in the U.S.: an exploratory analysis," Health Care Management Science, Springer, vol. 13(4), pages 378-387, December.
    34. Andrew Street, 2003. "How much confidence should we place in efficiency estimates?," Health Economics, John Wiley & Sons, Ltd., vol. 12(11), pages 895-907, November.
    35. repec:wly:hlthec:v:26:y:2017:i::p:5-22 is not listed on IDEAS
    36. 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.
    37. Massimiliano Piacenza & Gilberto Turati, 2014. "Does Fiscal Discipline Towards Subnational Governments Affect Citizens' Well‐Being? Evidence On Health," Health Economics, John Wiley & Sons, Ltd., vol. 23(2), pages 199-224, February.
    38. Daxin Sun & Haksoon Ahn & Tomas Lievens & Wu Zeng, 2017. "Evaluation of the performance of national health systems in 2004-2011: An analysis of 173 countries," PLOS ONE, Public Library of Science, vol. 12(3), pages 1-13, March.
    39. Signorelli, C. & Odone, A. & Oradini-Alacreu, A. & Pelissero, G., 2020. "Universal Health Coverage in Italy: lights and shades of the Italian National Health Service which celebrated its 40th anniversary," Health Policy, Elsevier, vol. 124(1), pages 69-74.
    40. Timothy J. Coelli & D.S. Prasada Rao & Christopher J. O’Donnell & George E. Battese, 2005. "An Introduction to Efficiency and Productivity Analysis," Springer Books, Springer, edition 0, number 978-0-387-25895-9, February.
    41. Del Vecchio, Mario & Fenech, Lorenzo & Prenestini, Anna, 2015. "Private health care expenditure and quality in Beveridge systems: Cross-regional differences in the Italian NHS," Health Policy, Elsevier, vol. 119(3), pages 356-366.
    42. Richard Heijink & Xander Koolman & Gert Westert, 2013. "Spending more money, saving more lives? The relationship between avoidable mortality and healthcare spending in 14 countries," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(3), pages 527-538, June.
    43. Fabio Pammolli & Francesco Porcelli & Francesco Vidoli & Guido Borà, 2015. "La spesa sanitaria delle Regioni in Italia - Saniregio 2015," Working Papers CERM 01-2015, Competitività, Regole, Mercati (CERM), revised 04 Jan 2016.
    44. Gearhart, Richard S. & Michieka, Nyakundi M., 2018. "A comparison of the robust conditional order-m estimation and two stage DEA in measuring healthcare efficiency among California counties," Economic Modelling, Elsevier, vol. 73(C), pages 395-406.
    45. Brijesh C Purohit, 2016. "Health Care System Efficiency: A Sub-State Level Analysis For Orissa (India)," Review of Urban & Regional Development Studies, Wiley Blackwell, vol. 28(1), pages 55-74, March.
    46. Retzlaff-Roberts, Donna & Chang, Cyril F. & Rubin, Rose M., 2004. "Technical efficiency in the use of health care resources: a comparison of OECD countries," Health Policy, Elsevier, vol. 69(1), pages 55-72, July.
    47. Greta Falavigna & Roberto Ippoliti, 2013. "L?efficienza dei sistemi sanitari regionali in Italia: pubblico o privato?," ECONOMIA E POLITICA INDUSTRIALE, FrancoAngeli Editore, vol. 2013(2), pages 29-49.
    48. Subal Kumbhakar, 2010. "Efficiency and productivity of world health systems: where does your country stand?," Applied Economics, Taylor & Francis Journals, vol. 42(13), pages 1641-1659.
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    More about this item

    Keywords

    Healthcare expenditure; regional healthcare systems; efficiency; LEA scores;
    All these keywords.

    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • R50 - Urban, Rural, Regional, Real Estate, and Transportation Economics - - Regional Government Analysis - - - General

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