Cost-Containment Policies and Hospital Efficiency: Evidence from a Panel of Italian Hospitals

Marini, Giorgia; Atella, Vincenzo; Belotti, Federico; Ilardi, Giuseppe; Daidone, Silvio

doi:10.2139/ssrn.2038398

Cited by 4 publications

(7 citation statements)

References 26 publications

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“…Examples of policy variables, that have been found to relate to the cost (efficiency) of local MSW collection and processing, are the collection method (Bello and Szymanski, 1996;De Jaeger et al, 2011) and collection frequency (De Jaeger et al, 2011;Dijkgraaf and Gradus, 2003). Atella et al (2012) and Atella et al (2014) highlighted how the institutional setting and administrative constraints of the highest level authorities strongly constrain the allocation choices of the lower level ones. A similar remark was made by De Jaeger and Rogge (2013) for the Flemish MSW policy where the MSW-policy is formulated to a large extent at the municipal level, however, the Flemish re-gional government is still responsible for setting the general environmental targets and policies, including waste-related policy matters.…”

Section: The Role Of Demographic and Socio-economic Characteristicsmentioning

confidence: 99%

Spatial directional robust Benefit of the Doubt approach in presence of undesirable output: An application to Italian waste sector

Fusco

Vidoli

Rogge

2020

Omega

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This paper introduces a new composite indicator method integrating the spatial dependence into the robust directional model in the case of undesirable outputs. The proposed approach is advantageous compared to the traditional and conditional robust BoD models in that it allows to compare the performance of individual units with local cluster of peers. The methodology has been tested on a very detailed database of Italian municipalities for the year 2015 in the municipal solid waste collection and processing sector and confirms the existence of strong local constraints linked to the disposal facilities planned by higher level Authorities.

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Section: The Role Of Demographic and Socio-economic Characteristicsmentioning

confidence: 99%

Spatial directional robust Benefit of the Doubt approach in presence of undesirable output: An application to Italian waste sector

Fusco

Vidoli

Rogge

2020

Omega

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“…Daidone and D'Amico applied panel‐data techniques to 108 Italian hospitals for the years 2000‐2005, used the Gini index as a proxy for hospital specialization, and also found a significantly positive association of specialization with efficiency. Both Atella et al and Herwartz and Strumann, conversely, found a negative relationship between the Gini index and hospital efficiency, the former among 1233 Italian hospitals for the years 1999‐2007, the latter in 1500 German hospitals for the period 1995‐2001. Capkun et al examined 2002‐2006 patient panel data from 142 Austrian hospitals and found that increased specialization resulted in shorter patient lengths of stay.…”

Section: Literature Reviewmentioning

confidence: 90%

“…Specialization can be expected to reduce costs, increase efficiency, and improve quality through capacity utilization, scale economies, and experience‐curve effects (eg, other studies).…”

Section: Literature Reviewmentioning

confidence: 99%

“…positive association of specialization with efficiency. Both Atella et al 35 and Herwartz and Strumann, 3 With respect to quality of care, finally, a series of studies have shown that hospitals with greater service-specific volumes, particularly for surgical procedures, tend to experience better outcomes (eg, other studies 33,[39][40][41][42][43][44][45][46][47][48] ). For example, Cram et al 46 compared patient outcomes for coronary surgeries between general hospitals and speciality cardiac hospitals, finding evidence of lower mortality rates in the latter.…”

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confidence: 99%

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Does DRG funding encourage hospital specialization? Evidence from the Italian National Health Service

Pessina

Nieddu

Rizzo

2018

Health Planning & Management

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Summary The impact of diagnosis‐related group (DRG)‐based funding has been analyzed along a wide range of dimensions. Its effects on hospital specialization, however, have been investigated only sparsely. This paper examines such effects in the context of the Italian National Health Service, where decentralization has produced a significant degree of variation in funding arrangements. To this end, a 9‐year panel data set covering 762 Italian public and private hospitals was analyzed using a finite mixture model approach. Hospital specialization was measured by the internal Herfindahl‐Hirschman Index. Three variables were introduced as proxies for the choices made by Italian Regions with respect to the development and use of their DRG systems. The best finite mixture model identified three groups of hospitals, two of which sizeable. Of these, one included nearly all public hospitals, while the other was composed almost exclusively of small and medium‐sized investor‐owned hospitals. Averagely, private and smaller hospitals showed a stronger tendency to specialize over time. The positive impact of DRG funding on the hospitals' propensity to specialize found only limited empirical support. Moreover, it emerged as comparatively much smaller for public hospitals vis à vis private ones.

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“…Our second objective is to demonstrate how an empirical comparison of hospital efficiency can be conducted using the example of two European countries: Italy and Germany. There have been several analyses of hospital efficiency within Italy [17][18][19][20][21][22][23] and within Germany [24][25][26][27][28][29][30][31]. In this study, we analyze the hospital efficiency in both countries by projecting the observations on the common frontier.…”

Section: Introductionmentioning

confidence: 99%

Comparing the Efficiency of Hospitals in Italy and Germany: Nonparametric Conditional Approach Based on Partial Frontier

Varabyova

Blankart

Torbica

et al. 2016

Health Care Manag Sci

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Traditional nonparametric frontier techniques to measure hospital efficiency have been criticized for their deterministic nature and the inability to incorporate external factors into the analysis. Moreover, efficiency estimates represent a relative measure meaning that the implications from a hospital efficiency analysis based on a single-country dataset are limited by the availability of suitable benchmarks. Our first objective is to demonstrate the application of advanced nonparametric methods that overcome the limitations of the traditional nonparametric frontier techniques. Our second objective is to provide guidance on how an international comparison of hospital efficiency can be conducted using the example of two countries: Italy and Germany. We rely on a partial frontier of order-m to obtain efficiency estimates robust to outliers and extreme values. We use the conditional approach to incorporate hospital and regional characteristics into the estimation of efficiency. The obtained conditional efficiency estimates may deviate from the traditional unconditional efficiency estimates, which do not account for the potential influence of operational environment on the production possibilities. We nonparametrically regress the ratios of conditional to unconditional efficiency estimates to examine the relation of hospital and regional characteristics with the efficiency performance. We show that the two countries can be compared against a common frontier when the challenges of international data compatibility are successfully overcome. The results indicate that there are significant differences in the production possibilities of Italian and German hospitals. Moreover, hospital characteristics, particularly bed-size category, ownership status, and specialization, are significantly related to differences in efficiency performance across the analyzed hospitals.

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Cost-Containment Policies and Hospital Efficiency: Evidence from a Panel of Italian Hospitals

Cited by 4 publications

References 26 publications

Spatial directional robust Benefit of the Doubt approach in presence of undesirable output: An application to Italian waste sector

Spatial directional robust Benefit of the Doubt approach in presence of undesirable output: An application to Italian waste sector

Does DRG funding encourage hospital specialization? Evidence from the Italian National Health Service

Comparing the Efficiency of Hospitals in Italy and Germany: Nonparametric Conditional Approach Based on Partial Frontier

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