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This article analyzes the role of United Nations Educational Scientific and Cultural Organization (UNESCO) sites on the enhancement of tourism destinations (TDs) performance, taking the Italian regions over the period 1995–2010 as a case study. Specifically, we aim at studying the effect of the inscription in the World Heritage List (WHL) upon the dynamics of the efficiency of the Italian regions as TDs. We use a two-stage data envelopment analysis window analysis, to detect efficiency trends and resort to both semiparametric pooled-truncated and panel data estimators to evaluate the determinants of the efficiency changes in TDs over time. Moreover, we test for the presence of spatial dependence in the efficiency of TDs. The results reveal that the WHL does not play a significant role in enhancing technical efficiency of TDs. These empirical findings are robust to alternative estimators and model specifications. Furthermore, the spatial analysis does not reveal significant spillover effects in the efficiency of TDs.

There is an ongoing debate about the effect of different reimbursement systems on hospital performance and quality of care. The present paper aims at contributing to this literature by analysing the impact of different hospital payment schemes on patients' outcomes in Italy. The Italian National Health Service is, indeed, a particularly interesting case since it has been subject to a considerable decentralization process with wider responsibilities devolved to regional governments. Therefore, great variability exists in the way tariffs are used, as Regions have settled them in accordance with the characteristics of health care providers. An empirical analysis of the Italian hospital system is carried out using data from the National Program for Outcome Assessment on mortality and readmissions for Acute Myocardial Infarction (AMI), Congestive Heart Failure (CHF), stroke and Chronic Obstructive Pulmonary Diseases (COPD) in the years 2009-2010. The results show that hospitals operating in Regions where prospective payments are used more extensively are generally associated with better quality of care.