Simone Gitto

Healthcare reform in Italy: an analysis of efficiency based on nonparametric methods

Over the past twenty years, important changes in the Italian health system have led to different approaches in organizing, delivering and financing health services throughout the countrys regions. In this paper, we assess the impacts that such changes have had on health efficiency. The analysis performed here is in two stages. In the first stage, healthcare efficiency is measured via bootstrapped Data Envelopment Analysis. In the second stage, the impacts of organizational and environmental variables on efficiency are investigated. Our results highlight that the organizational model adopted by the Lombardia region allows for the best results in healthcare efficiency in Italy. A process of administrative decentralization from the regional governments to local health units appears to be a source of inefficiency. Finally, patient mobility has a significant impact on healthcare efficiency.

Evaluating Italian public hospital efficiency using bootstrap DEA and CART

We estimate the efficiency of 390 Italian public hospitals in 2007, using the bias-corrected data envelopment analysis (DEA) estimates. Then, classification and regression tree (CART) methodology, based on the bias-corrected DEA results, is used to investigate the relationships between health efficiency of the hospitals, physicians, nurses, beds and discharges. The results show that the main factors affecting health efficiency of the Italian public hospitals are the number of beds and the number of discharges. Finally, the paper shows that a process of bed downsizing may result in a deterioration of health efficiency of the Italian public hospital.

Efficiency change, technological change and capital accumulation in Italian regions: a sectoral study

Abstract This paper examines the sources of labour productivity in the Italian regions during the period 1980–2004. Five economic sectors are investigated using data envelopment analysis (DEA) and taking into account productive specialisation and sector inefficiencies. Labour productivity change is decomposed into five components by means of Malmquist productivity indices: intra-sector efficiency change, composition efficiency change, input-biased technical change, magnitude component technical change and capital accumulation. Using bootstrap procedure, the components of labour productivity changes are statistically tested. Efficiency analysis shows that productive specialisation is not a source of inefficiency and efficiency gains can be obtained by sector-specific policies. Thus, it is possible to obtain improvements in efficiency in each sector of activity rather than reallocating resources among sectors. The results of the decomposition by sectors reveal heterogeneous sources of growth. The total economy has shown evidence of non-neutral technical change and, it has been found that agriculture, industry and construction experienced capital using technical change. The analysis of the decomposition of the labour productivity growth is complemented by an analysis of β-convergence.

Does Religious Diversity in Health Team Composition Affect Efficiency? Evidence from Dubai

Team cultural diversity, the degree to which working team members differ in culture-related factors, may affect healthcare teams’ outcomes. This paper focuses on one particular source of cultural diversity, namely religion, and examines its relation to the production efficiency of hospital wards. Building on the categorization-elaboration model of organizational diversity, the authors test an empirical model positing that team religious diversity has non-linear effects on efficiency, and considering the role of moderating variables of the relation diversity–efficiency. Empirically, the authors adopt a two-step approach, whereby the first step applies data envelopment analysis to estimate efficiency scores for each team, and the second investigates the effect of diversity and of moderating variables. The model is tested on a sample of hospital wards from three large hospitals in Dubai. The results suggest an inverse U-shaped relation between religious diversity and the wards’ efficiency. Evidence is provided that the relation is moderated by task complexity, task conflict, team leader tenure and diversity in nationality. This study advances research on the management of hospital team diversity by emphasizing the complexity of diversity effects and the importance of contextual factors.