Gianmaria Martini

Determinants of transient and persistent hospital efficiency: The case of Italy

In this paper, we extend the 4-random-component closed skew-normal stochastic frontier model by including exogenous determinants of hospital persistent (long-run) and transient (short-run) inefficiency, separated from unobserved heterogeneity. We apply this new model to a dataset composed by 133 Italian hospitals during the period 2008-2013. We show that average total inefficiency is about 23%, higher than previous estimates; hence, a model where the different types of inefficiency and hospital unobserved characteristics are not confounded allows us to get less biased estimates of hospital inefficiency. Moreover, we find that transient efficiency is more important than persistent efficiency, as it accounts for 60% of the total one. Last, we find that ownership (for-profit hospitals are more transiently inefficient and less persistently inefficient than not-for-profit ones, whereas public hospitals are less transiently inefficient than not-for-profit ones), specialization (specialized hospitals are more transiently inefficient than general ones; i.e., there is evidence of scope economies in short-run efficiency), and size (large-sized hospitals are better than medium and small ones in terms of transient inefficiency) are determinants of both types of inefficiency, although we do not find any statistically significant effect of multihospital systems and teaching hospitals.

FIRST MOVER ADVANTAGE IN A DYNAMIC DUOPOLY WITH SPILLOVER

We present a dynamic duopoly model of technical innovation in which R&D costs decrease exogenously with time and inter-firm knowledge spillover lowers the second comers R&D cost. The spillover effect only becomes available after a disclosure lag. These features allow us to identify a new type of equilibrium: the leader delays investment until the R&D cost is low enough that the follower finds it optimal to invest as soon as he can benefit from the spillover. This equilibrium is subgame perfect over a wide range of parameters and raises several interesting implications. First, in our new equilibrium, the time delay between the two R&D investments is realistically short. Second, while the presence of a spillover favors the second-mover, this benefit is not enough to rule out a first-mover advantage. Indeed, the first-mover advantage survives whenever technical progress is sufficiently fast and the disclosure lag is relatively long. Third, in case of a major innovation, our equilibrium implies under-investment, which requires a substantial public intervention in favor of the investment activity.

PAHA study: Psychological Active and Healthy Aging: psychological wellbeing, proactive attitude and happiness effects of whole-body vibration versus Multicomponent Training in aged women: study protocol for a randomized controlled trial

BackgroundEvidence demonstrates that physical exercise and psychological wellbeing are closely interlinked, particularly in older-aged women. However, research investigating how different forms of exercise influence mental health in older-aged women is underdeveloped.Methods/DesignA randomized controlled trial (N = 300) will assess the relative effectiveness of two different exercise programs (whole-body vibration and Multicomponent Training) for improving psychological wellbeing in older-aged women. The following outcomes will be assessed at three time points (that is, pre, post, and follow-up): psychological wellbeing, proactive attitude, quality of life, and happiness.DiscussionResults will have important implications for preventing psychological and physiological disease in older-aged women and for managing health-related costs for this population group.Trial registrationNumber NCT01966562 on Clinical Gov database the 8 October 2013

Tacit Collusion and Non-Uniform Prices

This article examines the possibility of building a tacit agreement between price–setters that yields non–uniform pricing. It is shown that firms with market power may restrict competition not only by alternating between periods of high prices and low prices (Green and Porter (1984), Rotemberg and Saloner (1986)), but also by always charging different prices and taking turns in being the monopolist. In contrast with the existing literature, price variability is not due to imperfect monitoring, stochastic demand or short–run pricing rigidity but it is a pure supply side effect. The author provides the necessary conditions to have collusion with non–uniform pricing, and shows that the latter dominates a fixed price solution. In terms of competition policy this result confirms that no price parallelism is not, per se, a signal of no collusion.

Administrative Data and Health Outcome Assessment: Methodology and Application

Abstract The goal of this contribution is to shed light on the benefits for research in health care coming from the use of administrative data, especially in terms of measuring hospitals’ outcomes. The main approaches to health outcome evaluation are reviewed and the possible improvements deriving from the use of administrative data are highlighted. Administrative data may be an essential element in the process of gathering to the public true rankings of health care organizations, reducing the degree of asymmetric information that typically arises in health care. Patients will be more aware of the best institutions, which will induce most of them to demand to be admitted in them, taking into account the costs associated with distance and with the severity of the illness. This in turn may ask for a reorganization of the sector, closing some organizations and expanding others, having as final goal to improve the health status of the population, without income barriers. This is one of the first attempts to provide an overview of the advantages that administrative data may gather in health care.

Air transport in Africa: A Critical Assessment

This chapter analyses the evolution of the African airline industry by looking at the main policies that have been adopted, trends in the various airline markets within and without Africa between 1997 and 2013 and changes in the airline industry in the near future as it confronts continuing institutional challenges. Despite the growth in traffic in both intra-African and intercontinental flows and the increases in both the number of airlines and the level of competition, air transportation in Africa is still suffering from some long-standing weaknesses, including a lack of interconnectivity, an unbalanced traffic distribution, higher (compared to the rest of the world) fares and airline costs, and sparse demand. In sum, the market for air services in Africa is, overall, clearly healthier than in the past but, with a few notable exceptions, still lacks the capacity and service levels found in most other parts of the world.

The redistributive effects of copayment in outpatient prescriptions: evidence from Lombardy

BackgroundIn Italy, copayment has changed its nature and it can no longer be simply considered a system to curb inappropriate expenditure. It has become an important form of revenue for public health care provision, but it might also become a source of distortions in income and health benefits redistribution.MethodsWe use a rich administrative dataset gathering information on patients demand (whose records have been matched to income declared for tax purposes) to study the effects of an additional copayment (the so called “superticket” introduced by the Italian government in 2012) in Lombardy, the biggest Italian Region whose socio-economic dimension is comparable to that of many European countries (e.g., the Netherlands, Switzerland, etc.).ResultsOur analysis shows that at the aggregate level the non-uniform superticket schedule adopted in Lombardy is slightly pro-poor, but this result coexists with evidences pointing towards possible cases of restriction to access caused by the additional copayment.ConclusionsThe introduction of the superticket and the ensuing increase in the out-of pocket payment for health care raises questions about the distribution of the burden among patients, and the sustainability of the extra revenue through time. This issue needs to be further investigated by combining health status data with the information in this dataset.

Fare elasticities of demand for direct and indirect flights in sub-Saharan Africa

ABSTRACT This article examines the different demands for direct and indirect flights within sub-Saharan Africa. It develops both a simple reduced form model and a more refined two equation simultaneously system to examine bookings and fares on the major air transportation corridors. Using panel data, this allows estimation of the different fare elasticities of demand for direct and indirect services between the continents’ major cities as well as assessing the respective merits of the two models used.

Impacts of the Arab Spring on trade in airline services

ABSTRACT This article examines the impacts of the ‘Arab Spring’ on trade in air services between the various North African and Levant countries involved. Studies of the implications of these socio-economic changes on trade in the region are made difficult because of a paucity of good economic data and the involvement of outside countries in the trade that now takes place. The number of international airline seats available provides a partial and fairly reliable variable to examine trade patterns. The analysis looks at changes in patterns of trade in these services between 1997 and 2013.