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How do hospital‐specialty characteristics influence health system responsiveness? An empirical evaluation of in‐patient care in the Italian region of Emilia‐Romagna

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  • Gianluca Fiorentini
  • Silvana Robone
  • Rossella Verzulli

Abstract

Studies of health system responsiveness mostly focus on the demand side by investigating the association between sociodemographic characteristics of patients and their reported level of responsiveness. However, little is known about the influence of supply‐side factors. This paper addresses that research gap by analysing the role of hospital‐specialty characteristics in explaining variations in patients' evaluation of responsiveness from a sample of about 38,700 in‐patients treated in public hospitals within the Italian Region of Emilia‐Romagna. The analysis is carried out by adopting a 2‐step procedure. First, we use patients' self‐reported data to derive 5 measures of responsiveness at the hospital‐specialty level. By estimating a generalised ordered probit model, we are able to correct for variations in individual reporting behaviour due to the health status of patients and their experience of being in pain. Second, we run cross‐sectional regressions to investigate the association between patients' responsiveness and potential supply‐side drivers, including waiting times, staff workload, the level of spending on non‐clinical facilities, the level of spending on staff education and training, and the proportion of staff expenditure between nursing and administrative staff. Results suggest that responsiveness is to some extent influenced by the supply‐side drivers considered.

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  • Gianluca Fiorentini & Silvana Robone & Rossella Verzulli, 2018. "How do hospital‐specialty characteristics influence health system responsiveness? An empirical evaluation of in‐patient care in the Italian region of Emilia‐Romagna," Health Economics, John Wiley & Sons, Ltd., vol. 27(2), pages 266-281, February.
    • Handle: RePEc:wly:hlthec:v:27:y:2018:i:2:p:266-281
    DOI: 10.1002/hec.3540
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    1. Huber, John D. & Stanig, Piero, 2011. "Church-state separation and redistribution," Journal of Public Economics, Elsevier, vol. 95(7), pages 828-836.
    2. Franco Peracchi & Claudio Rossetti, 2013. "The heterogeneous thresholds ordered response model: identification and inference," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 176(3), pages 703-722, June.
    3. Rice, N & Robone, S & Smith, P.C, 2008. "International Comparison of Public Sector Performance: The Use of Anchoring Vignettes to adjust Self-Reported Data," Health, Econometrics and Data Group (HEDG) Working Papers 08/28, HEDG, c/o Department of Economics, University of York.
    4. Nigel Rice & Silvana Robone & Peter Smith, 2011. "Analysis of the validity of the vignette approach to correct for heterogeneity in reporting health system responsiveness," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(2), pages 141-162, April.
    5. Fiorentini, Gianluca & Ragazzi, Giovanni & Robone, Silvana, 2015. "Are bad health and pain making us grumpy? An empirical evaluation of reporting heterogeneity in rating health system responsiveness," Social Science & Medicine, Elsevier, vol. 144(C), pages 48-58.
    6. Robone, S & Rice, N & Smith, P, 2010. "Health systems’ responsiveness and its characteristics: a cross-country comparative analysis," Health, Econometrics and Data Group (HEDG) Working Papers 10/29, HEDG, c/o Department of Economics, University of York.
    7. Röttger, Julia & Blümel, Miriam & Fuchs, Sabine & Busse, Reinhard, 2014. "Assessing the responsiveness of chronic disease care - Is the World Health Organization's concept of health system responsiveness applicable?," Social Science & Medicine, Elsevier, vol. 113(C), pages 87-94.
    8. Andrew M. Jones & Stefanie Schurer, 2011. "How does heterogeneity shape the socioeconomic gradient in health satisfaction?," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 26(4), pages 549-579, June.
    9. Michael Baker & Mark Stabile & Catherine Deri, 2004. "What Do Self-Reported, Objective, Measures of Health Measure?," Journal of Human Resources, University of Wisconsin Press, vol. 39(4).
    10. Stephen Pudney & Michael Shields, 2000. "Gender, race, pay and promotion in the British nursing profession: estimation of a generalized ordered probit model," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 15(4), pages 367-399.
    11. Nigel Rice & Silvana Robone & Peter C. Smith, 2012. "Vignettes and health systems responsiveness in cross‐country comparative analyses," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 175(2), pages 337-369, April.
    12. repec:cup:apsrev:v:98:y:2004:i:01:p:191-207_00 is not listed on IDEAS
    13. S. Robone & G. Fiorentini & M. A. Nicoli & S. Rodella, 2014. "La responsiveness dei sistemi sanitari: un analisi empirica sull assistenza ospedaliera nel Servizio Sanitario Regionale dell Emilia Romagna," Working Papers wp934, Dipartimento Scienze Economiche, Universita' di Bologna.
    14. Huber, John D. & Stanig, Piero, 2011. "Church-state separation and redistribution," Journal of Public Economics, Elsevier, vol. 95(7-8), pages 828-836, August.
    15. Nicolas Sirven & Brigitte Santos-Eggimann & Jacques Spagnoli, 2012. "Comparability of Health Care Responsiveness in Europe," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 105(2), pages 255-271, January.
    16. Andrew Street & Conrad Kobel & Thomas Renaud & Josselin Thuilliez & ON BEHALF OF THE EURODRG GROUP, 2012. "How Well Do Diagnosis‐Related Groups Explain Variations In Costs Or Length Of Stay Among Patients And Across Hospitals? Methods For Analysing Routine Patient Data," Health Economics, John Wiley & Sons, Ltd., vol. 21(S2), pages 6-18, August.
    17. Laudicella, Mauro & Olsen, Kim Rose & Street, Andrew, 2010. "Examining cost variation across hospital departments-a two-stage multi-level approach using patient-level data," Social Science & Medicine, Elsevier, vol. 71(10), pages 1872-1881, November.
    18. Fally, Thibault & Paillacar, Rodrigo & Terra, Cristina, 2010. "Economic geography and wages in Brazil: Evidence from micro-data," Journal of Development Economics, Elsevier, vol. 91(1), pages 155-168, January.
    19. Nicholas Bloom & Carol Propper & Stephan Seiler & John Van Reenen, 2015. "The Impact of Competition on Management Quality: Evidence from Public Hospitals," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 82(2), pages 457-489.
    20. Andrew Street & Conrad Kobel & Thomas Renaud & Josselin Thuilliez & ON BEHALF OF THE EURODRG GROUP, 2012. "How Well Do Diagnosis‐Related Groups Explain Variations In Costs Or Length Of Stay Among Patients And Across Hospitals? Methods For Analysing Routine Patient Data," Health Economics, John Wiley & Sons, Ltd., vol. 21(S2), pages 6-18, August.
    21. Qing Luo & Qi Wang & Zuxun Lu & Junan Liu, 2013. "Evaluation of Responsiveness of Community Health Services in Urban China: A Quantitative Study in Wuhan City," PLOS ONE, Public Library of Science, vol. 8(5), pages 1-8, May.
    22. Matteo Lippi Bruni & Irene Mammi, 2017. "Spatial effects in hospital expenditures: A district level analysis," Health Economics, John Wiley & Sons, Ltd., vol. 26(S2), pages 63-77, September.
    23. Valentine, Nicole & Verdes-Tennant, Emese & Bonsel, Gouke, 2015. "Health systems' responsiveness and reporting behaviour: Multilevel analysis of the influence of individual-level factors in 64 countries," Social Science & Medicine, Elsevier, vol. 138(C), pages 152-160.
    24. Teresa Bago d’Uva & Maarten Lindeboom & Owen O’Donnell & Eddy van Doorslaer, 2011. "Slipping Anchor?: Testing the Vignettes Approach to Identification and Correction of Reporting Heterogeneity," Journal of Human Resources, University of Wisconsin Press, vol. 46(4), pages 875-906.
    25. Omar Azfar & Tugrul Gurgur, 2008. "Does corruption affect health outcomes in the Philippines?," Economics of Governance, Springer, vol. 9(3), pages 197-244, July.
    26. Lewis, Jeffrey B. & Linzer, Drew A., 2005. "Estimating Regression Models in Which the Dependent Variable Is Based on Estimates," Political Analysis, Cambridge University Press, vol. 13(4), pages 345-364.
    27. Hendrik Jürges, 2007. "True health vs response styles: exploring cross‐country differences in self‐reported health," Health Economics, John Wiley & Sons, Ltd., vol. 16(2), pages 163-178, February.
    28. Leiter, Michael P. & Harvie, Phyllis & Frizzell, Cindy, 1998. "The correspondence of patient satisfaction and nurse burnout," Social Science & Medicine, Elsevier, vol. 47(10), pages 1611-1617, November.
    29. Valentine, Nicole & Darby, Charles & Bonsel, Gouke J., 2008. "Which aspects of non-clinical quality of care are most important? Results from WHO's general population surveys of "health systems responsiveness" in 41 countries," Social Science & Medicine, Elsevier, vol. 66(9), pages 1939-1950, May.
    30. Nigel Rice & Andrew Jones, 1997. "Multilevel models and health economics," Health Economics, John Wiley & Sons, Ltd., vol. 6(6), pages 561-575, November.
    31. Crossley, Thomas F. & Kennedy, Steven, 2002. "The reliability of self-assessed health status," Journal of Health Economics, Elsevier, vol. 21(4), pages 643-658, July.
    32. Miika Linna & Unto Häkkinen, 2006. "Reimbursing for the costs of teaching and research in finnish hospitals: A stochastic frontier analysis," International Journal of Health Economics and Management, Springer, vol. 6(1), pages 83-97, March.
    33. White, Halbert, 1980. "A Heteroskedasticity-Consistent Covariance Matrix Estimator and a Direct Test for Heteroskedasticity," Econometrica, Econometric Society, vol. 48(4), pages 817-838, May.
    34. George France & Francesco Taroni & Andrea Donatini, 2005. "The Italian health‐care system," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages 187-202, September.
    35. Hekkert, Karin Dorieke & Cihangir, Sezgin & Kleefstra, Sophia Martine & van den Berg, Bernard & Kool, Rudolf Bertijn, 2009. "Patient satisfaction revisited: A multilevel approach," Social Science & Medicine, Elsevier, vol. 69(1), pages 68-75, July.
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    3. Dolores Jiménez‐Rubio & Judit Vall Castelló, 2020. "Limiting health‐care access to undocumented immigrants: A wise option?," Health Economics, John Wiley & Sons, Ltd., vol. 29(8), pages 878-890, August.

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    More about this item

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I19 - Health, Education, and Welfare - - Health - - - Other
    • C25 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Discrete Regression and Qualitative Choice Models; Discrete Regressors; Proportions; Probabilities
    • C50 - Mathematical and Quantitative Methods - - Econometric Modeling - - - General

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