Understanding inappropriateness in health spending: The role of regional policies and institutions in caesarean deliveries

Francese, Maura; Piacenza, Massimiliano; Romanelli, Marzia; Turati, Gilberto

doi:10.1016/j.regsciurbeco.2014.02.006

Cited by 51 publications

(34 citation statements)

References 47 publications

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“…Differently, services acquired by the local health unit from hospitals located in another local health unit are reimbursed on a pay‐per‐case basis (Fabbri and Robone, ). This means that those hospitals with higher levels of Patient Flow are more sensitive to the financial incentive provided by the higher reimbursement rate of C‐sections versus vaginal deliveries (Francese et al , ). Consequently, the inclusion of both year fixed effects and Patient Flow allow us to control for financial incentives.…”

Section: Empirical Analysismentioning

confidence: 99%

Does Experience Rating Improve Obstetric Practices? Evidence from Italy

2015

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Using inpatient discharge records from the Italian region of Piedmont, we estimate the impact of an increase in malpractice pressure brought about by experience-rated liability insurance on obstetric practices. Our identification strategy exploits the exogenous location of public hospitals in court districts with and without schedules for noneconomic damages. We perform difference-in-differences analysis on the entire sample and on a subsample which only considers the nearest hospitals in the neighborhood of court district boundaries. We find that the increase in medical malpractice pressure is associated with a decrease in the probability of performing a C-section from 2.3 to 3.7 percentage points (7-11.6%) with no consequences for medical complications or neonatal outcomes. The impact can be explained by a reduction in the discretion of obstetric decision-making rather than by patient cream skimming.

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Section: Empirical Analysismentioning

confidence: 99%

Does Experience Rating Improve Obstetric Practices? Evidence from Italy

2015

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“…Our paper also contributes to the extensive literature on the determinants of treatment choices (e.g., Chandra, Cutler, & Song, ) and, specifically, of C‐section deliveries. This literature has investigated several explicative factors (see, e.g., the recent survey in Francese, Piacenza, Romanelli, & Turati, ), and the role played by reimbursement mechanisms is our main focus here. Each hospital is responsible for the choice of the appropriate treatment for delivery.…”

Section: Introductionmentioning

confidence: 99%

Do public hospitals respond to changes in DRG price regulation? The case of birth deliveries in the Italian NHS

et al. 2017

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We study how changes in Diagnosis-Related Group price regulation affect hospital behaviour in quasi-markets with exclusive provision by public hospitals. Exploiting a quasi-natural experiment, we use a difference-in-differences approach to test whether public hospitals respond to an exogenous change in Diagnosis-Related Group tariffs by increasing C-section rates and/or by upcoding. Controlling for a detailed set of mother characteristics, we find that price changes did not affect the probability of a C-section. We do however find evidence of upcoding: Conditional on the birth delivery method (either a C-section or a vaginal delivery), public hospitals experiencing the largest price change exhibit a higher probability of treating patients coded as complicated. This finding suggests that even public hospitals may be sensitive to market incentives.

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“…Considering that previous literature has pointed out that fiscal decentralization tends to reduce inefficient health spending (e.g., Francese et al, 2014), by making local governments 16 The coefficients for this set of controls are not included for brevity but they are available on request. 17 This interpretation is also supported by a robustness estimation -carried out on a subsample of 15 regions over the time period 1994-2006 -in which model [1] has been estimated by replacing the variable of health expenditure per-capita with an indicator of spending inefficiency as computed in Piacenza and Turati (2014), getting a negative coefficient for the inefficiency and results in line with those discussed above regarding the impact of fiscal decentralization.…”

Section: Estimation Resultsmentioning

confidence: 99%

“…As far as the Italian NHS is concerned, most works have focused on the relationship between decentralization and the efficiency of health policies (e.g., Bordignon and Turati, 2009;Piacenza and Turati, 2014;Francese et al, 2014). This literature provides support to modern fiscal federalism theories according to which fiscal decentralization makes local governments more accountable and efficient.…”

Section: Introductionmentioning

confidence: 81%

How Does Fiscal Decentralization Affect Within-Regional Disparities in Well-Being? Evidence from Health Inequalities in Italy

et al. 2015

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T his paper aim s at investigating em pirically the im pact of fiscal decentralization reform s on inequality in w ell -being. In particular, w e look at the effects on health inequalities follow ing the assignm ent of larger tax pow er to the Italian R egions for financing their health expenditure, starting from the end of the N ineties. E xploiting large differences in the size of the tax base across R egions, w e find that fiscal decentralization processes that attribute a greater tax pow er to low er governm ent tiers, besides reducing inefficiencies of healthcare policies, seem to be effective in reducing also w ithin-regional disparities in health outcom es. H ow ever, the degree of econom ic developm ent -on w hich depends the actual fiscal autonom y from C entral governm ent -significantly affects the effectiveness of these reform s and highlights the im portance to take properly into account the specific features of the context w here the decentralization of pow er is im plem ented. K eyw ords: AbstractThis paper aims at investigating empirically the impact of fiscal decentralization reforms on inequality in well-being. In particular, we look at the effects on health inequalities following the assignment of larger tax power to the Italian Regions for financing their health expenditure, starting from the end of the Nineties. Exploiting large differences in the size of the tax base across Regions, we find that fiscal decentralization processes that attribute a greater tax power to lower government tiers, besides reducing inefficiencies of healthcare policies, seem to be effective in reducing also within-regional disparities in health outcomes. However, the degree of economic development -on which depends the actual fiscal autonomy from Central government -significantly affects the effectiveness of these reforms and highlights the importance to take properly into account the specific features of the context where the decentralization of power is implemented.JEL codes: H75, I14, I18, R50.

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Understanding inappropriateness in health spending: The role of regional policies and institutions in caesarean deliveries

Cited by 51 publications

References 47 publications

Does Experience Rating Improve Obstetric Practices? Evidence from Italy

Does Experience Rating Improve Obstetric Practices? Evidence from Italy

Do public hospitals respond to changes in DRG price regulation? The case of birth deliveries in the Italian NHS

How Does Fiscal Decentralization Affect Within-Regional Disparities in Well-Being? Evidence from Health Inequalities in Italy

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