Amedeo Fossati

Delay is Not the Answer: Waiting Time in Health Care & Income Redistribution

In this paper, the use of delay as a tool to improve income redistribution is examined. We assume that people with the highest opportunity cost of waiting address their demand to the private market; if these, as we assume, are the ones at the higher end of the income distribution, they contribute through income tax, and pay for the private care they receive as well. Thus, public and private provision of health care, made mutually consistent within a utility-based approach by the presence of delay, may be used to modify income distribution. Our model modifies the results obtained by the current literature and shows that, when individual utilities are strictly quasi-concave and a cost-minimization framework is replaced by a Bergson-Samuelson welfare function maximisation, delay is no longer welfare improving. The reason is that, even when an optimum delay exists, the correspondent social maximum is a local maximum. The scope for using delay is then confined to environments where the Central Government’s power to tax is not sufficient to raise adequate resources or where, due to tax evasion or high tax distortions, second best tax instruments should be used.

The Italian Tradition in Public Finance: An Annotated Bibliography of Mauro Fasiani

This paper is directed to the enhancement of the scientific figure of Mauro Fasiani. In fact, he still does not occupy the proper place in scientific debate, either in Italy or abroad. Following his untimely death in 1950, his high reputation has not paid adequate historio-graphical interest. The aim is not to discuss Fasiani’s scientific thought, but only to draw it to the attention of the international scholars by letting known the content of his work. This is done by scaling down the over 3 thousands pages of his original works to the just over1 hundred pages of this paper.

The Double Taxation of Savings: The Italian Debate Revisited

In the first half of the 20th century, Italian scholars of public finance debated J. S. Mills theorem on the double taxation of savings. Building on I. Fishers contribution, L. Einaudi started the discussion, which lasted for some 30 years, involving a significant number of scholars. This paper critically discusses the crucial aspects of this debate, with the aim, firstly, to highlight its peculiarity and specificity with respect to the previous Anglo-Saxon literature. A second aim is to discuss critically, from a historiographical perspective, the main reasoning put forward in the debate.

Vilfredo Pareto and the methodology of the Italian tradition in public finance

In the last decade of the nineteenth century, Italian scholars started using a scientific methodology to tackle public finance problems. Their studies are now referred to as the Italian tradition in public finance, whose origin is considered to lie with De Viti de Marco (1888). Shortly before his death in 1950, Fasiani, the last scholar of the Italian tradition, published an important article, in which he showed that, even if Pareto never worked in public finance, he had some influence on the Italian public finance scholars. This paper aims to draw scholarly attention to the above article and to direct new light onto Pareto’s methodological influence on the Italian tradition. Firstly it is pointed out that the Paretian idea of science deeply influenced the late scholars of the Italian tradition. Secondly, it is shown that Paretian sociology was less important than his economic methodology. Thirdly, it is argued that it is necessary to distinguish the problems concerning the explanation of public choices, from the problems of the economic effects of public policies; then, in a generalized Paretian approach, most public policies may be studied under economic hypothesis. It follows that much of the Italian tradition may be taken back to a Paretian approach, even if it remains true that, in the latter, public choices may be explained by sociological reasoning only.

Vilfredo Pareto's influence on the Italian tradition in public finance: A critical assessment of Mauro Fasiani's appraisal

Abstract Even if Pareto never worked in public finance, he had some influence on the Italian public finance scholars. This paper aims to direct new light onto such a methodological influence. Firstly, it is pointed out that the Paretian idea of science deeply influenced the late scholars of the Italian tradition. Secondly, it is shown that Paretian sociology was less important than his economic methodology. Thirdly, it is argued that, in a generalized Paretian approach, most public policies may be studied under economic hypothesis; it remains true that, in the Paretian approach, public choices may be explained by sociological reasoning only.

Pareto and Italian Public Finance Scholars in the First Half of the XX Century

The paper discusses the influence of Pareto’s methodological revolution on the Italian scientific tradition in public finance. To that end, the works of the most celebrated scholars from within the first, second and final generations of this tradition are reviewed with reference to their reactions to Pareto’s idea of science as logico-experimental activities and his contributions to the development of marginalism and theoretical sociology. The particular scholars considered across his three generations time span include Pantaleoni, De Viti, Barone, Einaudi, Sensini, Griziotti, Borgatta, Murray and Fasiani. The main original contribution of this paper is the marshalling of evidence in support of the author’s proposition that Fasiani’s research programme is characterized by a clearly Paretian mode of enquiry with regard to methodology and the economic investigation of fiscal activities, although the specific influence of Pareto’s sociology on Fasiani’s approach to fiscal studies was relatively modest. It is provisionally concluded that, in taking the best and most relevant of Pareto’s work for fiscal studies, Fasiani’s contributions came to represent the highest point in evolution of the general theory of public finance in the Italian tradition.

The Idea of State in the Italian Tradition of Public Finance

Abstract The paper reviews some of the most representative Italian scholars, starting from De Viti de Marco and ending with Fasiani, conventionally considered the first and the last scholar of the Italian tradition. Their positions are discussed firstly in terms of the economic role they attributed to the State and, secondly, in terms of how they considered public goods and public needs. The paper then shows how their analysis depended on political, sociological and ethical assumptions about the State. Finally, it is argued that Italian tradition turned to alternative political and sociological approaches to the State.

Waiting Time and Public Health Care: A Comment to 'Public Health Care with Waiting Time: The Role of Supplementary Private Health Care'

In a recent article which appeared in this journal, Hoel and Saeter propose a model showing that welfare may be improved by introducing delay in public health care. In this note we argue that their model may be used as starting point because of their stringent assumptions. We suggest that the welfare properties of delay in the provision of health care should be further investigate.

Public Health Care with Waiting Time Revisited

In this model we use delay as a tool to improve income redistribution. Delay makes people with the highest opportunity cost of waiting leave the public health care market. If these, as we assume, are the ones at the higher end of the income distribution, they are made to pay twice for health care: they contribute through income tax, but they address their demand to the private health care system and pay for the care they receive. In this way public and private provision of health care is made mutually consistent within a utility-based approach. Our model extends the results obtained by Hoel and Saeter (2003) to a more general approach and shows that delay may be an optimal tool in the presence of distortionary taxation. However, delay might not always be welfare-improving, even when utility is linear and taxation non-distortionary. We show that this statement applies to the model proposed by HS as well, unless the specific normalisation proposed by the authors is used.

Razionalizzazione della spesa farmaceutica: farmaci costo efficaci in malattie cardiovascolari

The study presented in this paper applies the principles of economic evaluation to the allocation of pharmaceutical expenditure among different drugs. The analysis stems from the definition of cost effective drugs and the type of disease under study is cardivascular problems. This sector accounts for 25% of total expenditure, the drugs mostly come in the same format and belongs to group A, i.e. those drugs that are fully paid by the State. The work is structured in three different steps: the first one consists of a review of the literature to compare the effectiveness of the different drug principles, the second step is the comparison of the costs of the different principles and the determination of the cost effective ones. The third step consists of the substitution of the most cost effective one with those used at the moment in order to determine expenditure savings. The work presented here has mainly methodological goals for two main reasons: the studies considered are mainly of American origin and costs are often referred to this context, furthermore for some drugs we could not determine the expenditure due to the limitations imposed on the use of data. In any case the analysis proposed shows that there is scope for this type of analysis.