Health Expenditure and All-Cause Mortality in the ‘Galaxy’ of Italian Regional Healthcare Systems: A 15-Year Panel Data Analysis
The sustainability of healthcare systems is a topic of major interest. During periods of economic instability, policy makers typically reallocate resources and execute linear cuts in different areas of public spending, including healthcare.
The aim of this paper was to examine whether and how per capita public healthcare expenditure (PHE) in the Italian regions was related to the all-cause mortality rate (MR) between 1999 and 2013 and to determine which expenditure item most affected mortality in the short and very short term.
We conducted a pooled cross-sectional time series study. Secondary data were extracted from ‘Health for All’, a database released periodically by the Italian National Institute of Statistics. PHE is subdivided into directly provided services (DPS), pharmaceutical care, general practitioner care, specialist medical care, privately delivered hospital care, other privately delivered medical services, and psychiatric support and rehabilitation. We used a fixed-effects regression to assess the effects of PHE items on the MR after controlling for a number of socioeconomic and supply variables.
Higher spending on DPS was associated with a lower MR. Other expenditure variables were not significantly associated with the MR.
The results highlight the importance of medical services and goods provided directly by public services (i.e. hospital-based general and specialized wards and offices, emergency departments, etc.). DPS represents the driving force of the system and should be considered a determinant of the health of the Italian population. Our results suggest that the context and financing methods of a healthcare system should be carefully analysed before linear cuts are made or resources are reallocated.
The authors wish to express their gratitude to Allessandra Arduini for her precious help with the English review of this article. We would also like to thank Matteo Squadrani from University of Bologna, Italy, for his support in the first phase of this study.
DG: Had the idea of the study, conducted the study, interpreted the results, wrote the paper. FT: Shared the idea of the study, helped in study conduction, interpreted the results, wrote the paper. AB: Performed the statistical analysis, interpreted the results, drafted the methods section of the paper. JL: Supported the statistical analysis, drafted and reviewed the methods section of the paper. MPF: Revised the article critically for intellectual content. NN: Revised the article. GM: Critical revision, methodological and academic support.
Compliance with Ethical Standards
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Conflict of interest
Davide Golinelli, Fabrizio Toscano, Andrea Bucci, Jacopo Lenzi, Maria Pia Fantini, Nicola Nante and Gabriele Messina have no conflicts of interest to report.
- 8.Parmar D, Stavropoulou C, Ioannidis JPA. Health outcomes during the 2008 financial crisis in Europe: systematic literature review. BMJ. 2008;2016:i4588.Google Scholar
- 15.Mladovsky P, Srivastava D, Cylus J, Karanikolos M, Evetovits T, Thomson S, et al. Health policy responses to the financial crisis in Europe. 2012. https://www.lenus.ie/hse/handle/10147/267834. Accessed 27 Oct 2016.
- 17.Organisation for Economic Co-operation and Development. OECD reviews of health care quality: Italy 2014. Paris: OECD Publishing; 2015. http://www.oecd-ilibrary.org/social-issues-migration-health/oecd-reviews-of-health-care-quality-italy-2014_9789264225428-en. Accessed 26 Oct 2016.
- 18.Organisation for Economic Co-operation and Development. A system of health accounts. Paris: OECD Publishing; 2011. http://www.oecd-ilibrary.org/social-issues-migration-health/a-system-of-health-accounts_9789264116016-en Accessed 31 Mar 2017.
- 19.Bank European Central, editor. How the Euro became our money: a short history of the Euro banknotes and coins. Frankfurt: European Central Bank; 2007.Google Scholar
- 21.ISTAT. Health for All—Italia. Update June 2016. http://www.istat.it/it/archivio/14562. Accessed 12 Sept 2016.
- 22.World Bank Open Data. http://data.worldbank.org/. Accessed 12 Sept 2016.
- 30.SDA Bocconi, School of Management. Rapporto OASI 2015: Executive Summary. http://www.quotidianosanita.it/allegati/allegato4658035.pdf. Accessed 14 Aug 2017.
- 37.Ebeke MC, Loko MB, Viseth A. Credit Quality in Developing Economies: Remittances to the Rescue? International Monetary Fund Working paper WP/14/144. IMF; 2014.Google Scholar
- 43.NOMISMA. L’uso dei Farmaci in Italia. 2015. http://www.assogenerici.it/it/visualizza/rapporto-nomisma-2015-assogenerici.htm. Accessed 14 Aug 2017.