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Competition and Efficiency in health care: an analysis of the Italian case

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  • R. Cellini
  • G. Pignataro
  • I. Rizzo

Abstract

In this paper, we look at the Italian National Health System as a case study, in order to investigate whether competition exerts positive effect on the efficiency of the system. Using the DEA technique we measure the efficiency of accredited hospital production at the regional level; secondly, we take a cross-section regression analysis approach to analyse the determinants of efficiency. A general conclusion stemming out of the analysis is that competition is not a value per se and that its effects on the performance of the system are affected by the rules governing it.

Suggested Citation

  • R. Cellini & G. Pignataro & I. Rizzo, 1999. "Competition and Efficiency in health care: an analysis of the Italian case," Working Papers 354, Dipartimento Scienze Economiche, Universita' di Bologna.
    • Handle: RePEc:bol:bodewp:354
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    1. James F. Burgess, Jr. & Paul W. Wilson, 1996. "Hospital Ownership and Technical Inefficiency," Management Science, INFORMS, vol. 42(1), pages 110-123, January.
    2. R. D. Banker & A. Charnes & W. W. Cooper, 1984. "Some Models for Estimating Technical and Scale Inefficiencies in Data Envelopment Analysis," Management Science, INFORMS, vol. 30(9), pages 1078-1092, September.
    3. David W. Kalisch & Tetsuya Aman & Libbie A. Buchele, 1998. "Social and Health Policies in OECD Countries: A Survey of Current Programmes and Recent Developments," OECD Labour Market and Social Policy Occasional Papers 33, OECD Publishing.
    4. Nazrul Islam, 1995. "Growth Empirics: A Panel Data Approach," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 110(4), pages 1127-1170.
    5. Gerdtham, Ulf-G. & Löthgren, Mickael, 1998. "Health Care System Effects on Cost Efficiency in the OECD Countries," SSE/EFI Working Paper Series in Economics and Finance 247, Stockholm School of Economics.
    6. U.‐G. Gerdtham & M. Löthgren & M. Tambour & C. Rehnberg, 1999. "Internal markets and health care efficiency: a multiple‐output stochastic frontier analysis," Health Economics, John Wiley & Sons, Ltd., vol. 8(2), pages 151-164, March.
    7. Eulália Dalmau-Atarrodona & Jaume Puig-Junoy, 1998. "Market Structure and Hospital Efficiency: Evaluating Potential Effects of Deregulation in a National Health Service," Review of Industrial Organization, Springer;The Industrial Organization Society, vol. 13(4), pages 447-466, August.
    8. Zwanziger, Jack & Melnick, Glenn A., 1988. "The effects of hospital competition and the Medicare PPS program on hospital cost behavior in California," Journal of Health Economics, Elsevier, vol. 7(4), pages 301-320, December.
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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. Yauheniya Varabyova & Carl Rudolf Blankart & Aleksandra Torbica & Jonas Schreyögg, 2017. "Comparing the Efficiency of Hospitals in Italy and Germany: Nonparametric Conditional Approach Based on Partial Frontier," Health Care Management Science, Springer, vol. 20(3), pages 379-394, September.
    3. repec:ctc:serie1:def9 is not listed on IDEAS
    4. Padovano, Fabio, 2012. "The drivers of interregional policy choices: Evidence from Italy," European Journal of Political Economy, Elsevier, vol. 28(3), pages 324-340.
    5. Bettina Campedelli & Andrea Guerrina & Giulia Romano & Chiara Leardini, 2014. "La performance della rete ospedaliera pubblica della regione Veneto. L?impatto delle variabili ambientali e operative sull?efficienza," MECOSAN, FrancoAngeli Editore, vol. 2014(92), pages 119-142.
    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. Ancarani, A. & Di Mauro, C. & Giammanco, M.D., 2009. "The impact of managerial and organizational aspects on hospital wards' efficiency: Evidence from a case study," European Journal of Operational Research, Elsevier, vol. 194(1), pages 280-293, April.
    8. Maria Alessandra Antonelli & Giorgia Marini, 2023. "Good health with good institutions. An empirical analysis for italian regions," Public Finance Research Papers 61, Istituto di Economia e Finanza, DSGE, Sapienza University of Rome.
    9. Gianni De Fraja & Paola Valbonesi, 2009. "Mixed Oligopoly: Old and New," Discussion Papers in Economics 09/20, Division of Economics, School of Business, University of Leicester.
    10. Silvana Robone & Alberto Zanardi, 2006. "Market structure and technology: evidence from the Italian National Health Service," International Journal of Health Economics and Management, Springer, vol. 6(3), pages 215-236, September.
    11. Antonio Affuso & Cataldo Ferrarese & Guido Nannariello, 2013. "Spending Review: un?analisi di efficienza delle Capitanerie di porto," SCIENZE REGIONALI, FrancoAngeli Editore, vol. 2013(3), pages 111-143.
    12. Claudio Pinto, 2014. "Efficiency comparison for directly managed public hospitals for different geographical area in Italy," Working papers 5, Società Italiana di Economia Pubblica.
    13. Peter Dohmen & Martin Ineveld & Aniek Markus & Liana Hagen & Joris Klundert, 2023. "Does competition improve hospital performance: a DEA based evaluation from the Netherlands," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(6), pages 999-1017, August.
    14. Matranga, Domenica & Sapienza, Francesca, 2015. "Congestion analysis to evaluate the efficiency and appropriateness of hospitals in Sicily," Health Policy, Elsevier, vol. 119(3), pages 324-332.
    15. PINTO, Claudio, 2013. "Complexity of Treatment, and Changes in Efficiency and Productivity for Directly Managed Italian Hospitals," CELPE Discussion Papers 124, CELPE - CEnter for Labor and Political Economics, University of Salerno, Italy.
    16. Massimo Bordignon & Gilberto Turati, 2003. "Bailing Out Expectations and Health Expenditure in Italy," CESifo Working Paper Series 1026, CESifo.
    17. Elenka Brenna & Federico Spandonaro, 2014. "Does federalism induce patients’ mobility across regions? Evidence from the Italian experience," DISCE - Working Papers del Dipartimento di Economia e Finanza def009, Università Cattolica del Sacro Cuore, Dipartimenti e Istituti di Scienze Economiche (DISCE).
    18. Silvia Fedeli & Leone Leonida & Michele Santoni, 2018. "Bureaucratic institutional design: the case of the Italian NHS," Public Choice, Springer, vol. 177(3), pages 265-285, December.
    19. Bordignon, Massimo & Turati, Gilberto, 2009. "Bailing out expectations and public health expenditure," Journal of Health Economics, Elsevier, vol. 28(2), pages 305-321, March.
    20. Chew Lian Chua & Alfons Palangkaraya & Jongsay Yong, 2011. "Hospital Competition, Technical Efficiency and Quality," The Economic Record, The Economic Society of Australia, vol. 87(277), pages 252-268, June.

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