Gilberto Turati

Reforms of the National Health Service and dynamics of hospital efficiency in Piedmont

In this paper we estimate cost efficiency and technological characteristics of public hospitals in Piedmont over the period from 2000 to 2004. During the Nineties, different regulatory reforms aiming at controlling health expenditure affected the Italian National Health Service, ranging from the introduction of a new reimbursement scheme for hospitals (DRG-based) at the micro level, to the implementation of fiscal federalism at the macro level. We argue that all these legislative interventions rendered producers more prone to control costs, in order to be able to meet financial constraints. Our empirical findings support this hypothesis: average cost inefficiency, computed after estimating a Translog stochastic cost frontier by the Battese and Coelli (1992) approach, reduced remarkably during the observed years, while the adoption of more effective technologies shifted upward the minimum-cost frontier. We also find evidence of relevant scale economies not exploited by producers, which decrease with hospital size (number of beds) and output complexity (average DRG weight).

Spatial inequality in access to healthcare: evidence from an Italian Alpine region

ABSTRACT Potential access to healthcare facilities is one of the main determinants of health. This study investigates the extent of spatial inequalities in potential access to care, and the relationship between potential access and patients’ behaviour. Taking Piedmont, an Italian Alpine region, as a case study, the analysis emphasizes that potential access is not uniform within the region and lower potential access is associated with other important indicators of socioeconomic deprivation. Moreover, people living in places characterized by poor access tend to use healthcare services less often than other citizens, and to be less mobile than the rest of the population.

Do public hospitals respond to changes in DRG price regulation? The case of birth deliveries in the Italian NHS

We study how changes in Diagnosis-Related Group price regulation affect hospital behaviour in quasi-markets with exclusive provision by public hospitals. Exploiting a quasi-natural experiment, we use a difference-in-differences approach to test whether public hospitals respond to an exogenous change in Diagnosis-Related Group tariffs by increasing C-section rates and/or by upcoding. Controlling for a detailed set of mother characteristics, we find that price changes did not affect the probability of a C-section. We do however find evidence of upcoding: Conditional on the birth delivery method (either a C-section or a vaginal delivery), public hospitals experiencing the largest price change exhibit a higher probability of treating patients coded as complicated. This finding suggests that even public hospitals may be sensitive to market incentives.