Spatial effects in hospital expenditures: A district level analysis (original) (raw)
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Regional Science and Urban Economics, 2014
Spatial econometric models are now an established tool for measuring spillover effects between geographical entities. Unfortunately, however, when entities share common borders but are subject to different institutional frameworks, unless this is taken into account the conclusions may be misleading. In fact, under these circumstances, where institutional arrangements play a role, we should expect to find spatial effects mainly in entities within the same institutional setting, while the effect across different institutional settings should be small or nil even where the entities share a common border. In this case, factoring in only geographical proximity will produce biased estimates, due to the combination of two distinct effects. To avoid these problems, we derive a methodology that partitions the standard contiguity matrix into within-contiguity and between-contiguity matrices, allowing separate estimation of these spatial correlation coefficients and simple tests for the existence of institutional constraints. We then apply this methodology to Italian Local Health Authority expenditures, using spatial panel techniques. We find a high and significant spatial coefficient only for the within-contiguity effect, confirming the validity of our approach.
Social Science Research Network, 2013
Spatial econometric models are now an established tool for measuring spillover effects between geographical entities. Unfortunately, however, when entities share common borders but are subject to different institutional frameworks, unless this is taken into account the conclusions may be misleading. In fact, under these circumstances, where institutional arrangements play a role, we should expect to find spatial effects mainly in entities within the same institutional setting, while the effect across different institutional settings should be small or nil even where the entities share a common border. In this case, factoring in only geographical proximity will produce biased estimates, due to the combination of two distinct effects. To avoid these problems, we derive a methodology that partitions the standard contiguity matrix into within-contiguity and between-contiguity matrices, allowing separate estimation of these spatial correlation coefficients and simple tests for the existence of institutional constraints. We then apply this methodology to Italian Local Health Authority expenditures, using spatial panel techniques. We find a high and significant spatial coefficient only for the within-contiguity effect, confirming the validity of our approach.
Health Econometrics and Data Group Working Papers, 2008
It is evaluated that, each year, 35% out of the 10 million hospital admissions in Italy take place outside the LHAs of residence. In our paper we try to give an explanation of this phenomenon making reference to the social gravity model of spatial interaction. We estimate gravity equations using a Poisson pseudo maximum likelihood method, as proposed by Santos-Silva and Tenreyro (2006). Our results suggest that the gravity model is a good framework for explaining the patient mobility phenomenon for most of the examined diagnostic groups. Our evidence suggests that the ability to contain the imports of hospital services increases with the size of the pool of enrolees. Moreover we find that the ability to export hospital services, as proxied by the ratio of export-to-internal demand, is U-shaped. Therefore our evidence suggests that there are scale effect played by the size of the pool of enrolees.
Economic Analysis and Policy, 2017
The investigation of the determinants of public health expenditure is the focus of a vivid debate among health economists whereas the actual crisis of the welfare systems calls for the adoption of innovative tools to inform rational decisions, in the light of stringent budget constraints. The purpose of this paper is to show the potentialities of Artificial Neural Networks (ANNs) in investigating whether healthcare providers belonging to the same jurisdiction show similarities in their health care expenditure determinants. Similarities are reproduced in terms of fuzzy dependencies between health budgetary data of the healthcare providers belonging to five Italian regions. The analysis carried out sees the application of Auto Contractive Maps (AutoCM) model. The methodology is effective in illustrating regional patterns of expenditure and similarities across Local Health Units (Aziende Sanitarie Locali-ASLs). The results give interesting insights on the presence of notable regional models for health expenditure.
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In recent years, the accreditation of private hospitals followed by the decentralisation of the Italian NHS into 21 regional health systems, has furnished a good empirical ground for investigating the "voting with their feet" Tiebout principle. We consider the competition between public and private hospitals-and the rules supervising the financial agreements between regional authorities and providers of hospital care-as a potential determinant factor for cross border mobility in the Italian NHS. The model we propose considers an institutional variable set at a regional level that, ceteris paribus, succeeds in driving CBM flows towards accredited private hospitals. We assume that some northern and central regions accredited private providers not only to meet the internal need of hospital care, but also with the aim of attracting patients' inflows from other regions, particularly from the South of Italy, where the services supplied do not cover such a broad range of hospital specialization and/or do not guarantee the same perceived quality of care. The geographical gradient in this context is considerable: in 2011 the southern regions show a negative balance of-1.046 billion euro for patients' migration, while the northern ones report a surplus of 863 million euro. Evidence, both from the normative inspection and the statistical analysis, suggests the presence of strategic incentives provided by some regions with the twofold objective of accrediting a good quality health system and contextually overcoming the risk of production excess by driving financial resources from patients' inflows.
The geography of hospital admission in a national health service with patient choice
Health Economics, 2010
It is evaluated that, each year, 35% out of the 10 million hospital admissions in Italy take place outside the LHAs of residence. In our paper we try to give an explanation of this phenomenon making reference to the social gravity model of spatial interaction. We estimate gravity equations using a Poisson pseudo maximum likelihood method, as proposed by . Our results suggest that the gravity model is a good framework for explaining the patient mobility phenomenon for most of the examined diagnostic groups. Our evidence suggests that the ability to contain the imports of hospital services increases with the size of the pool of enrolees. Moreover we find that the ability to export hospital services, as proxied by the ratio of export-to-internal demand, is U-shaped. Therefore our evidence suggests that there are scale effect played by the size of the pool of enrolees.
Health Care in Italy: Expenditure Determinants and Regional Differentials
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Hospitals’ strategic behaviours and patient mobility: Evidence from Italy
Socio-Economic Planning Sciences, 2021
The aim of this study is to explore hospitals' behaviours in attracting extra-regional patients and to investigate the effects of these behaviours on the quality of care to resident patients in a context where choices by regional patients are constrained by a budget cap and extra-regional patients are unconstrained source of revenue. Empirical results suggest that, controlling for hospital fixed effects, patients' demographic and health characteristics, hospitals use waiting times and length of stay to attract exra-regional patients. Regional patients admitted in both private and public hospitals with higher proportions of extra-regional patients show lower mortality rates and reimbursement costs. These results suggest that competition increases the quality of care and reduces costs through spillover effects produced by the market for extra-regional patients. Finally, the pattern of reimbursement asked for extra-regional care generates a financial flow in favour of richer regions, exacerbating the north-south gradient in the Italian NHS.