TY - JOUR
T1 - Understanding inappropriateness in health spending
T2 - The role of regional policies and institutions in caesarean deliveries
AU - Francese, Maura
AU - Piacenza, Massimiliano
AU - Romanelli, Marzia
AU - Turati, Gilberto
N1 - Publisher Copyright:
© 2014 Elsevier B.V.
PY - 2014/11/1
Y1 - 2014/11/1
N2 - We analyze the determinants of caesarean sections and the role that regional policies and institutions can play in controlling for inappropriateness in healthcare. We consider Italy as a case study, given that: at the national level caesarean sections are above OECD average but regional variation is significant; almost all childbirths are managed within the National Health Service, in a public or a private hospital; regional governments are in charge of managing and funding (at least partially) health care services. Controlling for average patients' characteristics and the riskiness of births, in the attempt to separate "appropriate" from "inappropriate" treatments, we find that regional policies and institutions do matter. In particular, our results suggest that decentralised DRG tariffs might be an effective policy tool to control inappropriateness, once the role of private providers is taken into account. Also the degree of fiscal autonomy in funding regional health expenditure, and the experience of regional government's president are important.
AB - We analyze the determinants of caesarean sections and the role that regional policies and institutions can play in controlling for inappropriateness in healthcare. We consider Italy as a case study, given that: at the national level caesarean sections are above OECD average but regional variation is significant; almost all childbirths are managed within the National Health Service, in a public or a private hospital; regional governments are in charge of managing and funding (at least partially) health care services. Controlling for average patients' characteristics and the riskiness of births, in the attempt to separate "appropriate" from "inappropriate" treatments, we find that regional policies and institutions do matter. In particular, our results suggest that decentralised DRG tariffs might be an effective policy tool to control inappropriateness, once the role of private providers is taken into account. Also the degree of fiscal autonomy in funding regional health expenditure, and the experience of regional government's president are important.
KW - Health care
KW - Inappropriateness
KW - Political institutions
KW - Pricing policy
KW - Regional disparities
KW - Supply structure
UR - http://www.scopus.com/inward/record.url?scp=84913598578&partnerID=8YFLogxK
U2 - 10.1016/j.regsciurbeco.2014.02.006
DO - 10.1016/j.regsciurbeco.2014.02.006
M3 - Article
SN - 0166-0462
VL - 49
SP - 262
EP - 277
JO - Regional Science and Urban Economics
JF - Regional Science and Urban Economics
ER -