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Issue Date: 1-Mar-2013
Authors: Gitto, Lara Nicoletta Angela
Title: Analysis of the quality of hospital care: methodological and empirical issues in the Italian context
Abstract: The issue of quality in healthcare has constituted the object of several literature studies during the last decades. Many analyses have been carried out, for the most part in the EU and in the US, with the objective to define quality of hospital care and to identify appropriate indicators to measure it. This dissertation is aimed at analyzing quality of hospital care, considering aspects related to demand, supply and institutional factors, among which there is the modality of reimbursement. The observed scenario (Italy) is characterised by heterogeneity in the provision of health care; in fact, after the reforms intervened during the last 20 years, the Italian NHS is organised on a regional basis. Data employed in a cross section analysis, run for the year 2009, are those of the National Program for the Evaluation of health outcomes, carried out by the Ministry of Health with AGENAS. Other information about hospital structures have been extracted from the Ministry of Health database. Five different datasets, one for each outcome indicator, have been built. A random intercept model and a truncated regression have been applied, considering, as dependent variables, health outcomes related to 30 days mortality and readmission rates for specific conditions (acute myocardial infarction, congestive heart failure, stroke, chronic obstructive pulmonary disease). A positive impact on quality of hospital care due to the reimbursement systems was found: variables related to the extent of DRGs tariff implementation and the choice for a regional tariff were significantly correlated with quality indicators. Finally, an efficiency analysis at the level of provinces has been run, whose results outlined the role of institutional and environmental factors in determining improvements in terms of efficiency. The positive contribution given by the present dissertation to the literature related to the quality of hospital care is significant. Conclusions that can be drafted confirm the main results obtained in the literature. Moreover, the application to the Italian context allows to obtain relevant policy implications. There is a positive impact on quality due to the choice of reimbursement system; the greater autonomy accorded to the Region might favour competition within hospital sector based on quality.
Appears in Collections:Area 13 - Scienze economiche e statistiche

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