Death by austerity? The impact of cost containment on avoidable mortality in Italy

Abstract

Does austerity in health care affect health and healthcare outcomes? We examine the intended and unintended effects of the Italian austerity policy Piano di Rientro aimed at containing the cost of the healthcare sector. Using an instrumental variable strategy that exploits the temporal and geographical variation induced by the policy rollout, we find that the policy was successful in alleviating deficits by reducing expenditure, mainly in the southern regions, but also resulted in a 3% rise in avoidable deaths among both men and women, a reduction in hospital capacity and a rise in south-to-north patient migration. These findings suggest that-even in a high-income country with relatively low avoidable mortality like Italy-spending cuts can hurt survival.

The Effects of Health Sector Fiscal Decentralisation on Availability, Accessibility, and Utilisation of Healthcare Services: A Panel Data Analysis

“…The downward slope occurring in 2004, for example, is likely associated with the high deficits some regions generated, which required a bail-out from the national government and the enforcement of recovery plans, structural adjustments at local levels to achieve national macroeconomic objectives. 31,61 Similarly, the downward trend in 2009 suggests limited fiscal space for healthcare at regional levels coinciding with austerity policies and expenditure cuts implemented all through the great recession. 31 Results' general trend confirms the theoretical assumption that FD sits within a wide group of cost-containment and market-driven strategies.…”

“…Another explanation could be that these contradictory findings are merely a reflection of contradicting priorities between different actors within the healthcare system; increased private investment on profitable medical technology and coexisting public disinvestment from hospital care and healthcare workers due to austerity measures, especially during the Great Recession. 61,67 Similarly, the scarcity of regional financial resources for the training of new GPs to replace retiring ones explains the reduction of primary care physicians. 36,68 Austerity measures during the Great Recession may have contributed to further lower availability.…”

Right to Health and the Social Determinants of Health in the Face of COVID-19. Tthe Spanish Experience after Austerity Policies

“…However, besides this general conclusion, another question that remains is the extent to which health cuts and other austerity policies can affect health outcomes in developed countries with large health budgets. In a study on the health consequences of austerity policies in Italy, Arcà shows that they can lead to a significant increase in the number of preventable deaths (Arcà et al, 2020). This study is particularly relevant, since only 10 out of 20 Italian regions (mainly in the South) implemented such cuts, generating a sort of natural experiment that made possible a controlled assessment of these policies.…”

A Multinational Longitudinal Study Incorporating Intensive Methods to Examine Caregiver Experiences in the Context of Chronic Health Conditions: Protocol of the ENTWINE-iCohort

“…Due to medical advancements and the subsequent rise in longevity worldwide, societies everywhere are facing a growing ageing population with an increase in those living with chronic, often disabling health conditions. However, in spite of this, many countries, such as the United Kingdom, The Netherlands and Italy, have seen a decline in spending on social care over the past decade [ 1 , 2 ]. Although investment has taken place more recently adult social care is considered to be in crisis and a significant funding gap exists [ 1 , 2 ].…”

“…However, in spite of this, many countries, such as the United Kingdom, The Netherlands and Italy, have seen a decline in spending on social care over the past decade [ 1 , 2 ]. Although investment has taken place more recently adult social care is considered to be in crisis and a significant funding gap exists [ 1 , 2 ]. Whilst investment in social care services fails to meet demand, families are required to manage care more informally, with the burden of care typically falling to female family members [ 3 , 4 ].…”