The European Journal of Health Economics

, Volume 15, Issue 2, pp 117–132 | Cite as

Is there room for containing healthcare costs? An analysis of regional spending differentials in Italy

Original Paper

Abstract

This work aims at identifying the determinants of health spending differentials among Italian regions and at highlighting potential margins for savings. The analysis exploits a data set for the 21 Italian regions and autonomous provinces starting in the early 1990s and ending in 2006. After controlling for standard healthcare demand indicators, remaining spending differentials are found to be significant, and they appear to be associated with differences in the degree of appropriateness of treatments, health sector supply structure and social capital indicators. In general, higher regional expenditure does not appear to be associated with better reported or perceived quality in health services. In the regions that display poorer performances, inefficiencies appear not to be uniformly distributed among expenditure items. Overall, results suggest that savings could be achieved without reducing the amount of services provided to citizens. This seems particularly important given the expected rise in spending associated with the forecasted demographic developments.

Keywords

Government Expenditure Health Regional inequalities 

JEL Classification

H51 I1 

Notes

Acknowledgments

We thank two anonymous referees for their comments, the discussants and the participants at conferences and seminars where previous versions of this work were presented, and the colleagues at the Public Finance Division of the Bank of Italy. The usual disclaimers apply.

References

  1. 1.
    Battese, G., Coelli, T.: Frontier production functions, technical efficiency and panel data: with application to paddy farmers in India. J. Prod. Anal. 3, 153–169 (1992)CrossRefGoogle Scholar
  2. 2.
    Bodenheimer, T., Berry-Millet, R.: Follow the money—controlling expenditure by improving care for patients needing costly services. N. Engl. J. Med. 361, 1521–1523 (2009)PubMedCrossRefGoogle Scholar
  3. 3.
    Bordignon, M., Turati, G.: Bailing out expectations and public health expenditure. J.Health Econ. 28, 305–321 (2009)PubMedCrossRefGoogle Scholar
  4. 4.
    Cantanero Prieto D., Lago-Peñas S.: Decomposing the determinants of health care expenditure: the case of Spain. Eur. J. Health Econ. 13, 19–27 (2012)Google Scholar
  5. 5.
    Caroppo, M.S., Turati, G.: I sistemi sanitari regionali in Italia. Milano, Vita e Pensiero (2007)Google Scholar
  6. 6.
    Congressional Budget Office: Geographic variation in health care spending. CBO Paper 2978. Washington DC. (2008)Google Scholar
  7. 7.
    Cornwell, C., Schmidt, P., Sickles, R.: Production frontiers with cross sectional and time series variation in efficiency levels. J. Econom. 46, 185–200 (1990)CrossRefGoogle Scholar
  8. 8.
    Cutler D. M., Meara E.: The medical costs of the young and the old: a forty year perspective, NBER Working Papers 6114. Cambridge (MA). (1997)Google Scholar
  9. 9.
    de Blasio G., Nuzzo G.: The legacy of history for economic development: the case of Putnam’s social capital. Temi di Discussione, 591. Banca d’Italia, Roma. (2006)Google Scholar
  10. 10.
    De Matteis, P., Messina, G.: Le capacità fiscali delle Regioni italiane. Rivista economica del Mezzogiorno 3, 363–396 (2010)Google Scholar
  11. 11.
    Economic Policy Committee, European Commission: The 2009 ageing report: economic and budgetary projections for the EU-27 member states (2008–2060). Eur. Econ., 2 (2009)Google Scholar
  12. 12.
    Fisher, E.S., Bynum, J.P., Skinner, J.S.: Slowing the growth of healthcare costs—lessons from regional variation. N. Engl. J. Med. 360, 849–852 (2009)PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Fisher, E.S., Wennberg, D.E., Stukel, T.A., Gottlieb, D.J., Lucas, F.L., Pinder, E.L.: The implication of regional variations in Medicare spending. Part 1: the content, quality, and accessibility of care. Ann. Intern. Med. 138(4), 273–311 (2003)PubMedCrossRefGoogle Scholar
  14. 14.
    Fisher, E.S., Wennberg, D.E., Stukel, T.A., Gottlieb, D.J., Lucas, F.L., Pinder, E.L.: The implication of regional variations in Medicare spending. Part 2: health outcomes and satisfaction with care. Ann. Intern. Med. 138(4), 288–322 (2003)PubMedCrossRefGoogle Scholar
  15. 15.
    Fowler, F.J., Gallagher, P.M., Anthony, D.L., Larsen, K., Skinner, J.S.: Relationship between regional per capita medicare expenditures and patient perceptions of quality of care. J. Am. Med. Assoc. 299, 2406–2412 (2008)CrossRefGoogle Scholar
  16. 16.
    Francese M., Piacenza M., Romanelli M., Turati G.: Understanding inaprropriateness in health care. The role of supply structure, pricing policies and political institurions in caesarean deliveries. Working paper, 1. Department of Economics and Statistics, Università degli Studi di Torino, Torino (2012)Google Scholar
  17. 17.
    Francese M., Romanelli M.: Healthcare in Italy: expenditure determinants and regional differentials. Temi di Discussione, 828. Banca d’Italia, Roma (2011)Google Scholar
  18. 18.
    Gerdtham, U.G., Jönsson, B.: International comparisons of health expenditure: theory, data and econometric analysis. Handbook of Health Economics. Elsevier, Amsterdam (2000)Google Scholar
  19. 19.
    Gibbons L., Belizán J. M., Lauer J. A., Betrán A. P., Merialdi M., Althabe F.: The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: Overuse as a barrier to universal coverage. World health report background paper 30 (2010)Google Scholar
  20. 20.
    Giordano R., Tommasino P., Casiraghi M.: Behind public sector efficiency: the role of culture and institutions, European Commission Occasional paper, 45. Brussels (2009)Google Scholar
  21. 21.
    Greene, W.H.: Distinguishing between heterogeneity and inefficiency: stochastic frontier analysis of the World Health Organization’s panel data on national healthcare systems. Health Econ. 13, 959–980 (2004)PubMedCrossRefGoogle Scholar
  22. 22.
    Greene, W.H.: The econometric approach to efficiency analysis. In: Fried, H., Lovell, K., Schmidt, S. (eds.) The measurement of efficiency, pp. 92–250. Oxford University Press, Oxford (2008)Google Scholar
  23. 23.
    Iuzzolino G.: Domanda e offerta di servizi ospedalieri. Tendenze internazionali, Quaderni di Economia e Finanza (Occasional Papers), 27. Banca d’Italia, Roma (2008)Google Scholar
  24. 24.
    Jacobzone S.: Healthy ageing and the challenges of new technologies. Can OECD social and health-care systems provide for the future? In: OECD (ed.) Biotechnology and Healthy Ageing, Policy Implications of New Research, pp. 37–53. OECD, Paris (2002)Google Scholar
  25. 25.
    Kumbhakar, S.: Production frontiers and panel data, and time varying technical inefficiency. J. Econom. 46, 201–211 (1990)CrossRefGoogle Scholar
  26. 26.
    Ministero della Salute: Rapporto sull’attività di ricovero ospedaliero. Roma (various years)Google Scholar
  27. 27.
    Ministero della Salute: Rapporto nazionale di monitoraggio dei livelli essenziali di assistenza-anno 2004. Roma (2007)Google Scholar
  28. 28.
    Newhouse, J.P.: Medical care expenditure: a cross-national survey. J. Human Resour. 12, 115–125 (1977)CrossRefGoogle Scholar
  29. 29.
    Nixon, J., Ulmann, P.: The relationship between health care expenditure and health outcomes. Eur. J. Health Econ. 7, 7–18 (2006)PubMedCrossRefGoogle Scholar
  30. 30.
    OECD: Caesarean sections. In: OECD: Health at a Glance 2009: OECD Indicators. OECD Publishing, Paris (2009)Google Scholar
  31. 31.
    Putnam, R.: Making democracy work: civic tradition in modern Italy. Princeton University Press, Princeton (1993)Google Scholar
  32. 32.
    Schmidt, P., Sickles, R.: Production frontiers with panel data. J. Business Econ. Stat. 2(4), 367–374 (1984)Google Scholar
  33. 33.
    Skinner J. S., Fisher E. S., Wenneberg J.: The efficiency of Medicare. NBER Working Paper 8395. Cambridge (2001)Google Scholar
  34. 34.
    Yasaitis, L., Fisher, E.S., Skinner, J.S., Chandra, A.: Hospital quality and intensity of spending: is there an association? Health Aff. 28(4), 566–572 (2009)CrossRefGoogle Scholar
  35. 35.
    Wooldridge, J.M.: Econometric analysis of cross section and panel data. MIT Press, Cambridge (2002)Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Research and International RelationsBanca d’Italia-EconomicsRomeItaly

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