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Is austerity good for efficiency, at least? A counterfactual assessment for the Italian NHS

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  • Guccio, C.;
  • Pignataro, G.;
  • Romeo, D.;
  • Vidoli, F.;

Abstract

In recent decades, austerity measures have been widely adopted in public healthcare systems, so as to cope with financial constraints. This paper assesses the impact of a specific policy implemented in some Italian regions since 2007 with the purpose of reducing their healthcare spending deficit, the so called Recovery Plans (Piani di rientro), on the technical efficiency of their hospitals. Using a unique sample of administrative data relative to a large panel of hospitals in the period 2003-2010, and employing, as identification strategy, the exogenous introduction of the austerity policy in some regions, we find that the policy had a detrimental effect on the efficiency of the hospitals operating in the regions subjected to the policy. The results show that the efficiency loss grows over time, suggesting the existence of negative cumulative effects of the austerity policy.

Suggested Citation

  • Guccio, C.; & Pignataro, G.; & Romeo, D.; & Vidoli, F.;, 2022. "Is austerity good for efficiency, at least? A counterfactual assessment for the Italian NHS," Health, Econometrics and Data Group (HEDG) Working Papers 22/28, HEDG, c/o Department of Economics, University of York.
    • Handle: RePEc:yor:hectdg:22/28
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    1. Cristian Barra & Raffaele Lagravinese & Roberto Zotti, 2022. "Exploring hospital efficiency within and between Italian regions: new empirical evidence," Journal of Productivity Analysis, Springer, vol. 57(3), pages 269-284, June.
    2. Lindlbauer, Ivonne & Schreyögg, Jonas & Winter, Vera, 2016. "Changes in technical efficiency after quality management certification: A DEA approach using difference-in-difference estimation with genetic matching in the hospital industry," European Journal of Operational Research, Elsevier, vol. 250(3), pages 1026-1036.
    3. Mustafa U. Karakaplan & Levent Kutlu, 2017. "Endogeneity in panel stochastic frontier models: an application to the Japanese cotton spinning industry," Applied Economics, Taylor & Francis Journals, vol. 49(59), pages 5935-5939, December.
    4. Annamaria Nifo & Gaetano Vecchione, 2014. "Do Institutions Play a Role in Skilled Migration? The Case of Italy," Regional Studies, Taylor & Francis Journals, vol. 48(10), pages 1628-1649, October.
    5. Hung-jen Wang & Peter Schmidt, 2002. "One-Step and Two-Step Estimation of the Effects of Exogenous Variables on Technical Efficiency Levels," Journal of Productivity Analysis, Springer, vol. 18(2), pages 129-144, September.
    6. Gian Paolo Barbetta & Gilberto Turati & Angelo M. Zago, 2007. "Behavioral differences between public and private not‐for‐profit hospitals in the Italian national health service," Health Economics, John Wiley & Sons, Ltd., vol. 16(1), pages 75-96, January.
    7. Mustafa U. Karakaplan, 2022. "Panel stochastic frontier models with endogeneity," Stata Journal, StataCorp LP, vol. 22(3), pages 643-663, September.
    8. Carolin E. Pflueger & Su Wang, 2015. "A robust test for weak instruments in Stata," Stata Journal, StataCorp LP, vol. 15(1), pages 216-225, March.
    9. Roberto Colombi & Gianmaria Martini & Giorgio Vittadini, 2017. "Determinants of transient and persistent hospital efficiency: The case of Italy," Health Economics, John Wiley & Sons, Ltd., vol. 26(S2), pages 5-22, September.
    10. Mustafa U. Karakaplan & Levent Kutlu, 2017. "Handling Endogeneity in Stochastic Frontier Analysis," Economics Bulletin, AccessEcon, vol. 37(2), pages 889-901.
    11. Wenzl, Martin & Naci, Huseyin & Mossialos, Elias, 2017. "Health policy in times of austerity—A conceptual framework for evaluating effects of policy on efficiency and equity illustrated with examples from Europe since 2008," Health Policy, Elsevier, vol. 121(9), pages 947-954.
    12. Silvio Daidone & Francesco D’Amico, 2009. "Technical efficiency, specialization and ownership form: evidences from a pooling of Italian hospitals," Journal of Productivity Analysis, Springer, vol. 32(3), pages 203-216, December.
    13. Ben B. Hansen, 2004. "Full Matching in an Observational Study of Coaching for the SAT," Journal of the American Statistical Association, American Statistical Association, vol. 99, pages 609-618, January.
    14. Cinaroglu, Songul, 2021. "Changes in hospital efficiency and size: An integrated propensity score matching with data envelopment analysis," Socio-Economic Planning Sciences, Elsevier, vol. 76(C).
    15. Battese, G E & Coelli, T J, 1995. "A Model for Technical Inefficiency Effects in a Stochastic Frontier Production Function for Panel Data," Empirical Economics, Springer, vol. 20(2), pages 325-332.
    16. Greene, William, 2005. "Reconsidering heterogeneity in panel data estimators of the stochastic frontier model," Journal of Econometrics, Elsevier, vol. 126(2), pages 269-303, June.
    17. Atella, Vincenzo & Belotti, Federico & Bojke, Chris & Castelli, Adriana & Grašič, Katja & Kopinska, Joanna & Piano Mortari, Andrea & Street, Andrew, 2019. "How health policy shapes healthcare sector productivity? Evidence from Italy and UK," Health Policy, Elsevier, vol. 123(1), pages 27-36.
    18. Pınar Kaya Samut & Reyhan Cafrı, 2016. "Analysis of the Efficiency Determinants of Health Systems in OECD Countries by DEA and Panel Tobit," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 129(1), pages 113-132, October.
    19. Bruce Hollingsworth, 2008. "The measurement of efficiency and productivity of health care delivery," Health Economics, John Wiley & Sons, Ltd., vol. 17(10), pages 1107-1128, October.
    20. Christakis, Nicholas A. & Iwashyna, Theodore J., 2003. "The health impact of health care on families: a matched cohort study of hospice use by decedents and mortality outcomes in surviving, widowed spouses," Social Science & Medicine, Elsevier, vol. 57(3), pages 465-475, August.
    21. Willam Greene, 2005. "Fixed and Random Effects in Stochastic Frontier Models," Journal of Productivity Analysis, Springer, vol. 23(1), pages 7-32, January.
    22. Cavalieri, Marina & Di Caro, Paolo & Guccio, Calogero & Lisi, Domenico, 2020. "Does neighbours' grass matter? Testing spatial dependent heterogeneity in technical efficiency of Italian hospitals," Social Science & Medicine, Elsevier, vol. 265(C).
    23. Tiemann, Oliver & Schreyögg, Jonas & Busse, Reinhard, 2012. "Hospital ownership and efficiency: A review of studies with particular focus on Germany," Health Policy, Elsevier, vol. 104(2), pages 163-171.
    24. Depalo, Domenico, 2019. "The side effects on health of a recovery plan in Italy: A nonparametric bounding approach," Regional Science and Urban Economics, Elsevier, vol. 78(C).
    25. repec:wly:hlthec:v:26:y:2017:i::p:5-22 is not listed on IDEAS
    26. Simar, Leopold & Wilson, Paul W., 2007. "Estimation and inference in two-stage, semi-parametric models of production processes," Journal of Econometrics, Elsevier, vol. 136(1), pages 31-64, January.
    27. Alexis Diamond & Jasjeet S. Sekhon, 2013. "Genetic Matching for Estimating Causal Effects: A General Multivariate Matching Method for Achieving Balance in Observational Studies," The Review of Economics and Statistics, MIT Press, vol. 95(3), pages 932-945, July.
    28. Peña-Longobardo, L.M. & Rodríguez-Sánchez, B. & Oliva-Moreno, J., 2021. "The impact of widowhood on wellbeing, health, and care use: A longitudinal analysis across Europe," Economics & Human Biology, Elsevier, vol. 43(C).
    29. Kutlu, Levent, 2010. "Battese-coelli estimator with endogenous regressors," Economics Letters, Elsevier, vol. 109(2), pages 79-81, November.
    30. Massimo Bordignon & Silvia Coretti & Massimiliano Piacenza & Gilberto Turati, 2020. "Hardening subnational budget constraints via administrative subordination: The Italian experience of recovery plans in regional health services," Health Economics, John Wiley & Sons, Ltd., vol. 29(11), pages 1378-1399, November.
    31. Emanuele Arcà & Francesco Principe & Eddy Van Doorslaer, 2020. "Death by austerity? The impact of cost containment on avoidable mortality in Italy," Health Economics, John Wiley & Sons, Ltd., vol. 29(12), pages 1500-1516, December.
    32. Rajiv D. Banker & Ram Natarajan, 2008. "Evaluating Contextual Variables Affecting Productivity Using Data Envelopment Analysis," Operations Research, INFORMS, vol. 56(1), pages 48-58, February.
    33. de Belvis, Antonio Giulio & Ferrè, Francesca & Specchia, Maria Lucia & Valerio, Luca & Fattore, Giovanni & Ricciardi, Walter, 2012. "The financial crisis in Italy: Implications for the healthcare sector," Health Policy, Elsevier, vol. 106(1), pages 10-16.
    34. Boffardi, Raffaele, 2022. "How efficient is the Italian health system? Evidence on the role of political-institutional dynamics," Socio-Economic Planning Sciences, Elsevier, vol. 84(C).
    35. Marina Cavalieri & Calogero Guccio & Domenico Lisi & Giacomo Pignataro, 2018. "Does the Extent of per Case Payment System Affect Hospital Efficiency?," Public Finance Review, , vol. 46(1), pages 117-149, January.
    36. Manhal Ali & Reza Salehnejad & Mohaimen Mansur, 2018. "Hospital heterogeneity: what drives the quality of health care," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(3), pages 385-408, April.
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    Cited by:

    1. Guccio, C. & Pignatora, G. & Vidoli, F., 2023. "It never rains but it pours: Austerity and mortality rate in peripheral areas," Health, Econometrics and Data Group (HEDG) Working Papers 23/02, HEDG, c/o Department of Economics, University of York.

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    More about this item

    Keywords

    hospitals; recovery plans; technical efficiency; austerity; spending cuts;
    All these keywords.

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • D24 - Microeconomics - - Production and Organizations - - - Production; Cost; Capital; Capital, Total Factor, and Multifactor Productivity; Capacity

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