IDEAS home Printed from https://ideas.repec.org/p/ipu/wpaper/72.html
   My bibliography  Save this paper

The dark side of fiscal federalism:evidence from hospital care in Italy

Author

Listed:
  • Paolo Berta

    (Università di Milano Bicocca)

  • Carla Guerriero

    (Università di Napoli Federico II)

  • Rosella Levaggi

    (Università di Brescia)

Abstract

We use 2009-14 data from patients hospital discharges to assess the effects of fiscal federalism on the quality of care provided to regional and extraregional patients in Lombardy. Empirical results suggest that even after controlling for hospital fixed effects, patients demographic and health characteristics, extraregional patients wait less compared to regional ones, stay longer in hospital and are associated with higher reimbursement costs. However, private and public hospitals with higher proportion of extraregional patients show a lower mortality and lower reimbursement costs. This result suggest that competition works because of the spillovers effects that the market for extraregional patients produces.

Suggested Citation

  • Paolo Berta & Carla Guerriero & Rosella Levaggi, 2018. "The dark side of fiscal federalism:evidence from hospital care in Italy," Working papers 72, Società Italiana di Economia Pubblica.
    • Handle: RePEc:ipu:wpaper:72
    as

    Download full text from publisher

    File URL: http://www.siepweb.it/siep/wp/wp-content/uploads/repec/1535829267Berta_et_al_WP_SIEP_738.pdf
    File Function: Full text
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Daniele Fabbri & Silvana Robone, 2010. "The geography of hospital admission in a national health service with patient choice," Health Economics, John Wiley & Sons, Ltd., vol. 19(9), pages 1029-1047, September.
    2. Gaynor, Martin & Town, Robert J., 2011. "Competition in Health Care Markets," Handbook of Health Economics, in: Mark V. Pauly & Thomas G. Mcguire & Pedro P. Barros (ed.), Handbook of Health Economics, volume 2, chapter 0, pages 499-637, Elsevier.
    3. Rosella Levaggi & Francesco Menoncin, 2013. "Soft budget constraints in health care: evidence from Italy," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(5), pages 725-737, October.
    4. Rosella Levaggi, 2008. "The Regional Organization of Hospital Care in Italy: The Effects of Asymmetry of Information and Soft Budget Constraint Rules," Springer Books, in: Fabio Padovano & Roberto Ricciuti (ed.), Italian Institutional Reforms: A Public Choice Perspective, chapter 0, pages 197-219, Springer.
    5. Michele Bisceglia & Roberto Cellini & Luca Grilli, 2018. "Regional regulators in health care service under quality competition: A game theoretical model," Health Economics, John Wiley & Sons, Ltd., vol. 27(11), pages 1821-1842, November.
    6. Brekke, Kurt Richard & Siciliani, Luigi, 2011. "Quality competition with profit constraints: Do non-profit firms provide higher quality than for-profit firms?," CEPR Discussion Papers 8284, C.E.P.R. Discussion Papers.
    7. Laura Levaggi & Rosella Levaggi, 2017. "Oligopolistic competition for the provision of hospital care," Working papers 57, Società Italiana di Economia Pubblica.
    8. Unknown, 2005. "Forward," 2005 Conference: Slovenia in the EU - Challenges for Agriculture, Food Science and Rural Affairs, November 10-11, 2005, Moravske Toplice, Slovenia 183804, Slovenian Association of Agricultural Economists (DAES).
    9. Silvia Balia & Rinaldo Brau & Emanuela Marrocu, 2018. "Interregional patient mobility in a decentralized healthcare system," Regional Studies, Taylor & Francis Journals, vol. 52(3), pages 388-402, March.
    10. Brekke, Kurt R. & Siciliani, Luigi & Straume, Odd Rune, 2012. "Quality competition with profit constraints," Journal of Economic Behavior & Organization, Elsevier, vol. 84(2), pages 642-659.
    11. Brekke, Kurt R. & Levaggi, Rosella & Siciliani, Luigi & Straume, Odd Rune, 2014. "Patient mobility, health care quality and welfare," Journal of Economic Behavior & Organization, Elsevier, vol. 105(C), pages 140-157.
    12. 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.
    13. Kurt R. Brekke & Luigi Siciliani & Odd Rune Straume, 2015. "Hospital Competition with Soft Budgets," Scandinavian Journal of Economics, Wiley Blackwell, vol. 117(3), pages 1019-1048, July.
    14. Brenna, Elenka, 2011. "Quasi-market and cost-containment in Beveridge systems: The Lombardy model of Italy," Health Policy, Elsevier, vol. 103(2), pages 209-218.
    15. Paolo Berta & Gianmaria Martini & Francesco Moscone & Giorgio Vittadini, 2016. "The association between asymmetric information, hospital competition and quality of healthcare: evidence from Italy," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 179(4), pages 907-926, October.
    16. Brekke, Kurt R. & Levaggi, Rosella & Siciliani, Luigi & Straume, Odd Rune, 2016. "Patient mobility and health care quality when regions and patients differ in income," Journal of Health Economics, Elsevier, vol. 50(C), pages 372-387.
    17. Nuti, Sabina & Vola, Federico & Bonini, Anna & Vainieri, Milena, 2016. "Making governance work in the health care sector: evidence from a ‘natural experiment’ in Italy," Health Economics, Policy and Law, Cambridge University Press, vol. 11(1), pages 17-38, January.
    18. Mark V. Pauly & Thomas G. Mcguire & Pedro P. Barros (ed.), 2011. "Handbook of Health Economics," Handbook of Health Economics, Elsevier, volume 2, number 2.
    19. Paolo Berta & Chiara Seghieri & Giorgio Vittadini, 2013. "Comparing health outcomes among hospitals: the experience of the Lombardy Region," Health Care Management Science, Springer, vol. 16(3), pages 245-257, September.
    20. repec:wly:hlthec:v:26:y:2017:i::p:92-105 is not listed on IDEAS
    21. Rosella Levaggi & Roberto Zanola, 2004. "Patients' migration across regions: the case of Italy," Applied Economics, Taylor & Francis Journals, vol. 36(16), pages 1751-1757.
    22. Adolph, Christopher & Greer, Scott L. & Massard da Fonseca, Elize, 2012. "Allocation of authority in European health policy," Social Science & Medicine, Elsevier, vol. 75(9), pages 1595-1603.
    23. Kurt R. Brekke & Roberto Cellini & Luigi Siciliani & Odd Rune Straume, 2012. "Competition in Regulated Markets with Sluggish Beliefs about Quality," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 21(1), pages 131-178, March.
    24. Jones, Philip R. & Cullis, John G., 1996. "Decision making in quasi-markets: A pedagogic analysis," Journal of Health Economics, Elsevier, vol. 15(2), pages 187-208, April.
    25. Fattore, Giovanni & Petrarca, Giuseppina & Torbica, Aleksandra, 2014. "Traveling for care: Inter-regional mobility for aortic valve substitution in Italy," Health Policy, Elsevier, vol. 117(1), pages 90-97.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Berta, Paolo & Guerriero, Carla & Levaggi, Rosella, 2021. "Hospitals’ strategic behaviours and patient mobility: Evidence from Italy," Socio-Economic Planning Sciences, Elsevier, vol. 77(C).
    2. S. Balia & Rinaldo Brau & E. Marrocu, 2014. "Free patient mobility is not a free lunch. Lessons from a decentralised NHS," Working Paper CRENoS 201409, Centre for North South Economic Research, University of Cagliari and Sassari, Sardinia.
    3. Lippi Bruni, Matteo & Ugolini, Cristina & Verzulli, Rossella, 2021. "Should I wait or should I go? Travelling versus waiting for better healthcare," Regional Science and Urban Economics, Elsevier, vol. 89(C).
    4. Paolo Berta & Gianmaria Martini & Daniele Spinelli & Giorgio Vittadini, 2022. "The beaten paths effect on patient inter‐regional mobility: An application to the Italian NHS," Papers in Regional Science, Wiley Blackwell, vol. 101(4), pages 945-977, August.
    5. Levaggi, Laura & Levaggi, Rosella, 2020. "Is there scope for mixed markets in the provision of hospital care?," Social Science & Medicine, Elsevier, vol. 247(C).
    6. Brekke, Kurt R. & Canta, Chiara & Siciliani, Luigi & Straume, Odd Rune, 2021. "Hospital competition in a national health service: Evidence from a patient choice reform," Journal of Health Economics, Elsevier, vol. 79(C).
    7. Martini, Gianmaria & Levaggi, Rosella & Spinelli, Daniele, 2022. "Is there a bias in patient choices for hospital care? Evidence from three Italian regional health systems," Health Policy, Elsevier, vol. 126(7), pages 668-679.
    8. Claudio Pinto, 2017. "Perceived quality and formation of inter-regional networks of health care migration," Advances in Management and Applied Economics, SCIENPRESS Ltd, vol. 7(3), pages 1-5.
    9. Guccio, Calogero & Lisi, Domenico & Pignataro, Giacomo, 2014. "Readmission and Hospital Quality under Prospective Payment System," MPRA Paper 56490, University Library of Munich, Germany.
    10. Bell-Aldeghi, Rosalind & Chopard, Bertrand, 2021. "Hospital multi-dimensional quality competition with medical malpractice," International Review of Law and Economics, Elsevier, vol. 68(C).
    11. Emanuela Marrocu & Silvia Balia & Rinaldo Brau, 2016. "A spatial analysis of inter-regional patient mobility in Italy," ERSA conference papers ersa16p127, European Regional Science Association.
    12. Lisi, Domenico & Moscone, Francesco & Tosetti, Elisa & Vinciotti, Veronica, 2021. "Hospital quality interdependence in a competitive institutional environment: Evidence from Italy," Regional Science and Urban Economics, Elsevier, vol. 89(C).
    13. Michele Bisceglia & Roberto Cellini & Luca Grilli, 2019. "Quality Competition in Healthcare Services with Regional Regulators: A Differential Game Approach," Dynamic Games and Applications, Springer, vol. 9(1), pages 1-23, March.
    14. Elenka Brenna & Federico Spandonaro, 2014. "Does federalism induce patients’ mobility across regions? Evidence from the Italian experience," DISCE - Working Papers del Dipartimento di Economia e Finanza def009, Università Cattolica del Sacro Cuore, Dipartimenti e Istituti di Scienze Economiche (DISCE).
    15. Levaggi, Rosella & Moretto, Michele & Pertile, Paolo, 2023. "Dynamic, incentive-compatible contracting for health services," FEEM Working Papers 338404, Fondazione Eni Enrico Mattei (FEEM).
    16. Li, Zhong-Ping & Wang, Jian-Jun, 2021. "Effects of healthcare quality and reimbursement rate in a hospital association," Socio-Economic Planning Sciences, Elsevier, vol. 76(C).
    17. repec:ctc:serie1:def9 is not listed on IDEAS
    18. Rubino, Claudio & Di Maria, Chiara & Abbruzzo, Antonino & Ferrante, Mauro, 2022. "Socio-economic inequality, interregional mobility and mortality among cancer patients: A mediation analysis approach," Socio-Economic Planning Sciences, Elsevier, vol. 82(PA).
    19. Seghieri, Chiara & Berta, Paolo & Nuti, Sabina, 2019. "Geographic variation in inpatient costs for Acute Myocardial Infarction care: Insights from Italy," Health Policy, Elsevier, vol. 123(5), pages 449-456.
    20. Michele Bisceglia & Roberto Cellini & Luca Grilli, 2018. "Regional regulators in health care service under quality competition: A game theoretical model," Health Economics, John Wiley & Sons, Ltd., vol. 27(11), pages 1821-1842, November.
    21. Balia, Silvia & Brau, Rinaldo & Moro, Daniela, 2020. "Choice of hospital and long-distances: Evidence from Italy," Regional Science and Urban Economics, Elsevier, vol. 81(C).

    More about this item

    Keywords

    Hospital competition; patients mobility; mixed market; fiscal federalism;
    All these keywords.

    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • H77 - Public Economics - - State and Local Government; Intergovernmental Relations - - - Intergovernmental Relations; Federalism
    • D6 - Microeconomics - - Welfare Economics
    • C70 - Mathematical and Quantitative Methods - - Game Theory and Bargaining Theory - - - General

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:ipu:wpaper:72. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Monica Bozzano (email available below). General contact details of provider: .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.