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Does the Extent of Per-Case Payment System Affect Hospital Efficiency? Evidence from the Italian NHS


  • Cavalieri, M.
  • Guccio, C.
  • Lisi, D.
  • Pignataro, G.


Recently increasing public pressure to contain costs in the healthcare sector has led many national governments to introduce some type of prospective payment system and reduce the scope of global budgeting. This study investigates the extent to which the reimbursement systems of the Italian hospital sector have an impact on hospitals’ technical efficiency. Because of high variation in the financing and provision of healthcare servicesamong regions and hospitals, Italy represents an interesting case study to test these effects. A two-stage Data Envelopment Analysis was employed, in which the efficiency scores of all Italian hospitals were first calculated and then regressed on different environmental variables to capture the role of reimbursement systems. The results found a significant impact of the use of Diagnostic-Related Group-based prospective payment systems on hospitals’ efficiency.

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  • Cavalieri, M. & Guccio, C. & Lisi, D. & Pignataro, G., 2015. "Does the Extent of Per-Case Payment System Affect Hospital Efficiency? Evidence from the Italian NHS," Health, Econometrics and Data Group (HEDG) Working Papers 15/29, HEDG, c/o Department of Economics, University of York.
  • Handle: RePEc:yor:hectdg:15/29

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    Cited by:

    1. Bisceglia, Michele & Cellini, Roberto & Grilli, Luca, 2017. "Regional regulators in healthcare service under quality competition: A game theoretical model," MPRA Paper 80507, University Library of Munich, Germany.

    More about this item


    hospital efficiency; Data Envelopment Analysis; prospective payment systems; hospital ownership type;

    JEL classification:

    • C14 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods and Methodology: General - - - Semiparametric and Nonparametric Methods: General
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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