Waiting times are a major policy concern in publicly funded health systems across OECD countries. Economists have argued that, in the presence of excess demand, waiting times act as nonmonetary prices to bring demand for and supply of health care in equilibrium. Using administrative data disaggregated by region and surgical procedure over 2010-2014 in Italy, we estimate demand and supply elasticities with respect to waiting times. We employ linear regression models with first differences and instrumental variables to deal with endogeneity of waiting times. We find that demand is inelastic to waiting times while supply is more elastic. Estimates of demand elasticity are between −0.15 to −0.24. Our results have implications on the effectiveness of policies aimed at increasing supply and their ability to reduce waiting times.
We aim to investigate the cost containment effects of the creation in 2005 of agencies specifically responsible for all technical and administrative services within the regional healthcare system of the Tuscany region of Italy. We seek to contribute to the existing literature on the centralization and decentralization of purchases and technical services by assessing the amount of savings produced by these agencies at the intermediate level between local authorities and hospitals and the regional administration. We use the balances of all Italian local health authorities and hospital trusts combined with the synthetic control procedure to create from a donor pool of untreated units a weighted average of observations resembling the exposed units before and after the policy change in 2005. The magnitude of the effect is significant as the creation of these agencies is estimated to have reduced expenditures on auxiliary goods and contracted services by 6% in the period from 2006-2014. Moreover, we find that the cost reduction is not associated with a decrease in the provision of healthcare services and procedures to the general population or in the quality or efficiency of the regional healthcare system itself. K E Y W O R D Scost containment, goods, local health markets, services | INTRODUCTION AND INSTITUTIONAL BACKGROUNDIndustrialized countries are experiencing population aging, which is one of the most powerful drivers of increased healthcare costs (Zweifel, Felder, & Meiers, 1999). There is a large body of literature that estimates the increase in healthcare costs in advanced economies due to population change, with some recent examples being Ha et al. (2014) in
We provide novel and comprehensive evidence on the net fiscal contributions of natives and migrants to the governmental budgets of EU countries. We account for income taxes and cash benefits, along with indirect taxes and in-kind benefits, which are often missing in standard datasets. We find that on average, migrants were net contributors to public finances over the period of 2014–2018 in the EU and, moreover, that they contribute approximately €1.5 thousand more per capita each year than natives. We also show that this difference is partly due to the selection on characteristics that make migrants net fiscal contributors, such as demographic factors and employment probability.
We provide novel and comprehensive evidence on the net fiscal contributions of natives and migrants to the governmental budgets of EU countries. We account for income taxes and cash benefits, along with indirect taxes and in-kind benefits, which are often missing in standard datasets. We find that on average, migrants were net contributors to public finances over the period of 2014--2018 in the EU and, moreover, that they contribute approximately 1.5 thousand Euro more per capita each year than natives. We also show that this difference is partly due to the selection on characteristics that make migrants net fiscal contributors, such as demographic factors and employment probability.
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