Silvio Daidone

Rising Food Prices and Undernourishment - A Cross-Country Inquiry

Households’ welfare in developing countries has been hit by dramatic food prices increases which occurred between 2005 and 2008. In this paper, we adopt a partial equilibrium approach to analyze the short-time effects of a staple food price increase on nutritional attainments, as a measure of welfare. The analysis consists of first approximating complete food-demand systems and then performing household level micro-simulations. Instead of focusing on a single country profile, we provide a more complete snapshot by comparing the evidence through a cross-country assessment made possible by the use of nationally representative household surveys. Comparability is assured by the adoption of the same methodological choices in the treatment of the micro data. We find that food price spikes not only reduce the mean consumption of dietary energy, but also worsen the distribution of food calories, further deteriorating the nutritional status of populations. We also discovered that access to agricultural land plays a significant role in ensuring adequate nutritional attainments in rural areas, and surprisingly, even in urban areas.

Hospital variation in patient-reported outcomes at the level of EQ-5D dimensions: evidence from England.

Background. The English Department of Health has introduced routine collection of patient-reported outcome data for selected surgical procedures to facilitate patient choice and increase hospital accountability. However, using aggregate health outcome scores, such as EQ-5D utilities, for performance assessment purposes causes information loss and raises statistical and normative concerns. Objectives. For hip replacement surgery, we explore a) the change in patient-reported outcomes between baseline and follow-up on 5 health dimensions (EQ-5D), b) the extent to which treatment impact varies across hospitals, and c) the extent to which hospital performance on EQ-5D dimensions is correlated with performance on the EQ-5D utility index. Methods. We combine information on pre- and postoperative EQ-5D outcomes with routine inpatient data for the financial year 2009–2010. The sample consists of 21,000 patients in 153 hospitals. We employ hierarchical ordered probit risk-adjustment models that recognize the multilevel nature of the data and the response distributions. The treatment impact is modeled as a random coefficient that varies at the hospital level. We obtain hospital-specific empirical Bayes (EB) estimates of this coefficient. We estimate separate models for each EQ-5D dimension and the EQ-5D utility index and analyze correlations of EB estimates across these. Results. Hospital treatment is associated with improvements in all EQ-5D dimensions. Variability in treatment impact is most pronounced on the mobility and usual activities dimensions. Conversely, only pain/discomfort and anxiety/depression correlate well with performance measures based on utilities. This leads to different assessments of hospital performance across metrics. Conclusions. Our results indicate which hospitals are better than others in improving health across particular EQ-5D dimensions. We demonstrate the importance of evaluating dimensions of the EQ-5D separately for the purposes of hospital performance assessment.

Estimating the Costs of Specialised Care

In most sectors of the economy, specialisation is associated with lower costs. Yet some specialised hospitals claim to require more generous funding than general hospitals. This claim is based on the assertion that their patients are different, and that these differences outweigh the cost advantages of specialisation. Unless the basis for this claim can be established, the financial incentives introduced by Payment by Results to encourage cost reducing behaviour will be diluted.

How much should be paid for specialised treatment

English health policy has moved towards establishing specialist multi-disciplinary teams to care for patients suffering rare or particularly complex conditions. But the healthcare resource groups (HRGs), which form the basis of the prospective payment system for hospitals, do not explicitly account for specialist treatment. There is a risk, then, that hospitals in which specialist teams are based might be financially disadvantaged if patients requiring specialised care are more expensive to treat than others allocated to the same HRG. To assess this we estimate the additional costs associated with receipt of specialised care. We analyse costs for 12,154,599 patients treated in 163 English hospitals in fiscal year 2008/09 according to the type of specialised care received, if any. We account for the distributional features of patient cost data, and estimate ordinary least squares and generalised linear regression models with random effects to isolate what influence the hospital itself has on costs. We find that, for nineteen types of specialised care, patients do not have higher costs than others allocated to the same HRG. However, costs are higher if a patient has cancer, spinal, neurosciences, cystic fibrosis, childrens, rheumatology, colorectal or orthopaedic specialised services. Hospitals might be paid a surcharge for providing these forms of specialised care. We also find substantial variation in the average cost of treatment across the hospital sector, due neither to the provision of specialised care nor to other characteristics of each hospitals patients.

Technical Efficiency, Specialization and Ownership Form: Evidences from a Pooling of Italian Hospitals

We evaluate how the productive structure and level of specialization of a hospital affect technical efficiency by analyzing a six-year panel database (2000/2005) drawn from hospital discharge records and Ministry of Health data. We adopt a distance function approach, while measuring the technical efficiency level with stochastic frontier techniques. After controlling for environmental variables and hospital case-mix, inefficiency is negatively associated with specialization and positively associated with capitalization. Capitalization is typical of private structures which, on average, use resources less efficiently with respect to public and not-for-profit hospitals. Finally, by looking at scale elasticities, we find some evidence of unexploited economies of scale, leaving room for centralization.

Is Graduation from Social Safety Nets Possible? Evidence from Sub-Saharan Africa

In the last decade social cash transfer programmes have become extremely popular in sub-Saharan Africa, and often portrayed as an instrument that can facilitate graduation out of poverty. The evidence on whether social cash transfers have had actual effects on graduation, however, is limited. This paper provides a cross-country reflection of the potential effects of social cash transfers on graduation, drawing from impact evaluation results of cash transfer programmes in Ghana, Kenya, Lesotho and Zambia. We analyse whether social cash transfers have improved the likelihood of graduation, through increased productivity, income generation and resilience to shocks. We identify which factors in terms of programme implementation and household characteristics can increase the likelihood of cash transfer programmes facilitating graduation from poverty.

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

The main objective of this article is to evaluate to which extent the set of national and regional cost control policies implemented in recent years in Italy have affected hospital activity. Our contribution is mainly empirical as we focus our attention on the impact that policies like hospital mergers and regional bailout plans had on inefficiency. We use a rich longitudinal sample of Italian hospitals over the period 1999-2007 and perform a Bayesian analysis of the random-effects stochastic frontier model proposed by Greene (2005), allowing for a one-step estimation of both production frontier parameters and inefficiency effects. Results show that hospital inefficiency has changed over time and that part of this change could be ascribed to the mentioned policies.

An Extended Cross-Country Database for Agricultural Investment and Capital

This paper presents a database of investment and capital in agriculture, an essential input for cross-country macro analysis of the primary sector of the economy. Our work stems from the innovative research undertaken by Larson et al. (2000). With respect to these authors, we extend country coverage and time span. Further we introduce some refinements to the methodology used to construct the series of fixed capital stock by changing how the agricultural GDP and investment is forecasted. Finally we document in details our data sources and the STATA program used to implement all the methods.

Myth-busting? Confronting Six Common Perceptions about Unconditional Cash Transfers as a Poverty Reduction Strategy in Africa

This paper summarizes evidence on six perceptions associated with cash transfer programming, using eight rigorous evaluations conducted on large-scale government unconditional cash transfers in sub-Saharan Africa under the Transfer Project. Specifically, it investigates if transfers: 1) induce higher spending on alcohol or tobacco; 2) are fully consumed (rather than invested); 3) create dependency (reduce participation in productive activities); 4) increase fertility; 5) lead to negative community-level economic impacts (including price distortion and inflation); and 6) are fiscally unsustainable. The paper presents evidence refuting each claim, leading to the conclusion that these perceptions—insofar as they are utilized in policy debates—undercut potential improvements in well-being and livelihood strengthening among the poor, which these programs can bring about in sub-Saharan Africa, and globally. It concludes by underscoring outstanding research gaps and policy implications for the continued expansion of unconditional cash transfers in the region and beyond.

Did the Butler Really Do It? Examining the Impact of Technology on Hospital Cost Growth

We examine the extent to which hospital technologies are associated with growth in U.S. hospital costs. We create an index capturing the availability of a range of technologies in 2214 hospitals and track over the period 1996-2007, along with financial information from Medicare Cost Reports. We find that our measures of technology availability are positively correlated with hospital costs, consistent with the view that technology is an important driver of costs. However, we find that even controlling for a large number of technologies leaves a significant portion of the growth in U.S. hospital costs unexplained. While this may at least in part reflect effects of technology not captured by our measures, it suggests that the drivers of hospital cost growth go significantly beyond commonly conceptualized measures of technological change. Finally, we identify innovations that are cost increasing or cost-saving, and the time pattern of these effects.