Death by Austerity? The Impact of Cost Containment on Avoidable Mortality in Italy

Abstract

Does austerity in health care affect health and healthcare outcomes? We examine the intended and unintended effects of the Italian austerity policy Piano di Rientro aimed at containing the cost of the healthcare sector. Using an instrumental variable strategy that exploits the temporal and geographical variation induced by the policy rollout, we find that the policy was successful in alleviating deficits by reducing expenditure, mainly in the southern regions, but also resulted in a 3% rise in avoidable deaths among both men and women, a reduction in hospital capacity and a rise in south-to-north patient migration. These findings suggest that-even in a high-income country with relatively low avoidable mortality like Italy-spending cuts can hurt survival.

Efficiency and equity effects of healthcare decentralization: evidence from Italy

“…However, evidence is less clear-cut regarding their impact on health outcomes and access to healthcare services. For instance, Bordignon et al (2020) do not find any significant effect of recovery plans on citizens' health and on the perceived quality of services, while, using a different methodology, Depalo (2019) estimates an increase in mortality rates in some regions, and Arcà et al (2020) estimate a 3 per cent rise in avoidable deaths, a reduction in hospital capacity and a rise in south-to-north patient migration as a consequence of recovery plans. A comprehensive study by Aimone et al (2019) stresses that recovery plans achieved mixed economic results, because some regions still suffer from deficits.…”

Demografska analiza uticaja zdravstvene zaštite i javnog zdravlja na trendove smrtnosti stanovništva Srbije

“…Поставља се питање да ли се могу правдати било каква ограничења када је у питању доступност здравствене заштите (Sørensen, Andersen, 2019) и да ли се то може сматрати рационалним смањивањем јавне потрошње. Студије су показале да таква смањења имају негативан утицај на морталитет становништва (Arcà et al, 2020). Потврду о значају улагања у здравство дало је и истраживање у Аустралији, где је показано да повећање трошкова од 1% може повољно утицати на смртност и смањити за 2,2% стопу превремене смртности (Edney et al, 2018).…”

Administrative Border Effects in COVID-19 Related Mortality

“…The first is the recent literature on the correlates and determinants of Covid-19 related mortality (see Section 4 for a brief review). The second is the literature investigating the role of the characteristics of health systems, such the level of health spending (Arcà et al, 2020;Mays and Smith, 2011), supply (Godøy and Huitfeldt, 2020) and their organization modes (van Lerberghe et al, 2014), on population's health outcomes and mortality.…”