Exploring hospital efficiency within and between Italian regions: new empirical evidence

Cristian Barra,Raffaele Lagravinese,Roberto Zotti

doi:10.1007/s11123-022-00633-4

Abstract

This paper investigates the efficiency of Italian hospitals and how their performances have changed over the years 2007–2016, characterized by the great economic recession and budget constraints. We apply the Benefit of Doubt (BoD) approach to determine a composite index that considers the multi-dimensionality of the hospital outcome to be used as main output in a metafrontier production function based on a stochastic frontier framework. The efficiency score distribution is then used to construct a Theil index in order to compare, over time, the inequality of the estimated efficiency between hospitals, both within and between regions. The main findings show that the primary source of inefficiency comes from managerial inefficiency especially for hospitals located in southern regions. A clear and persistent North-South gap in efficiency performances of hospitals has been found along with an increase in the inequality in terms of efficiency between the areas of the country mostly determined by between region inequality.

Highlights

The Italian National Health Service (NHS), introduced in 1978, is a universal health care system providing comprehensive health insurance coverage and uniform health benefits to the whole population
The main findings show that the primary source of inefficiency comes from managerial inefficiency especially for hospitals located in southern regions
This paper investigates the efficiency of Italian hospitals and how their performances have changed over the period 2007–2016

Summary

Introduction

The Italian National Health Service (NHS), introduced in 1978, is a universal health care system providing comprehensive health insurance coverage and uniform health benefits to the whole population. It is inspired by the two fundamental pillars enshrined in Article 32 of the Italian Constitution: universality and equality. As in other European countries (see Costa-Font and Greer (2013)), the Italian NHS has undergone important reforms to decentralize health management and policy responsibilities to the sub-layers of government (Turati, 2013). As a result of a federal reform (Legislative Decree 56/2000), each region is in charge of organizing the health system, following the general guidelines defined by the central government that is responsible for setting the Essential Levels of Health Services (LEA, Livelli Essenziali di Assistenza). the separation of financing from expenditure responsibilities in the provision of LEA, and before LEA in the provision of uniform

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