It never rains but it pours: Austerity and mortality rate in peripheral areas.

This study examines the impact of austerity measures on mortality rates across Italian regions from 2003 to 2018. Since 2007, regions experiencing substantial healthcare financial deficits have been required to implement recovery plans (RPs). We use a recent difference-in-differences staggered matching estimator to assess the effects of this austerity policy on municipal-level monthly mortality rates. This allows us to evaluate the policy's spatial heterogeneity across treated municipalities, accounting for their distance from the nearest hospital. The analysis reveals a significant negative impact of austerity measures on health, particularly in peripheral areas and among vulnerable populations. Mortality rates are higher in regions under RPs, with this effect escalating with increasing distance from hospitals. The policy's impact is also more pronounced among vulnerable populations, with differences observed between genders and across seasons.

Spatial heterogeneity in non-parametric efficiency: An application to Italian hospitals.

This paper introduces a new empirical procedure for the estimation of hospitals' technical efficiency in presence of spatial heterogeneity. We propose a methodology that allows treating spatial heterogeneity independently of a predetermined reference to administrative borders. We define geographical spatial regimes, characterised by spatial proximity and homogeneity of relevant demand characteristics, within which to assess the efficiency of hospitals. The methodology has then been tested on a large sample of Italian hospitals, for which their production efficiency has been assessed within homogeneous demand areas.

[Essential levels of care and mode of admission: a trial of cost-volume contracts]. / LEA e riconversione dei ricoveri: sperimentazione di contratti per costo e volume.

Within a research project funded by the Ministry of Health, the purpose of this work was to define the procedures of a contract for the provision of health services (hospital admissions), between the regional health administration (the "buyer") and the University teaching hospital (the "provider"), with the aim of improving efficiency. The contract concerned a few DRGs, among those identified as being "at risk of inappropriateness", in the national decree on "essential levels of care" (LEA). The contract defined production levels (number and percentage of admissions in day hospital), financing rules and methods for evaluation of results and improvement of performance within the hospital. This trial, even if run for a limited time and for demonstration purposes, showed that some results can be attained, provided some organizational adjustments are made.