ESSAYS IN HEALTH ECONOMICS:EVIDENCES FROM ITALY

This thesis is an attempt to contribute to Italian literature on health economics in causal framework. Despite the increasing awareness of ruling class that is time to enforce the National Health System to achieve higher efficiency levels and to make the public system bearable, there are few contributions in scientific literature that study Italian context, maybe due to scarce availability of data. This thesis deals with two big concerns for public regulators: cost-containment policies and waiting times for elective surgeries. The first part regards cost-containment policies and the introduction of unified authorities responsible for purchases of goods and provision of services at local level. The aim of the first part is to measure the efficacy of these new authorities in terms of costs reduction. The straightforward policy implication is that if the unification of local health authorities can help administrations to perform scale economies, this would be a successful stimulus to other administrations to adopt the same hint and therefore create a virtuous cycle. The second chapter refers to waiting times for elective surgeries, especially their relation with the combination of capacity constraints, demand for and supply of elective treatments. From a policy perspective, it is critical to establish the extent to which demand and supply respond to waiting time. For example, if demand is highly elastic, an exogenous increase in supply will only have minimal effect in reducing waiting times. In turn, this will make policymakers more reluctant to fund additional resources. Similarly, if supply is elastic, an exogenous increase in demand will imply that waiting time will increase only to a small extent. In both chapters we use public and free administrative data and widely known econometric approaches (Instrumental Variable regression and Synthetic Control) to try to establish causal relations between important factors in healthcare sector and try to fill the gap between literature on Italian health care sector and scientific production concerning other OECD and European Countries. Our findings are emerging at a sufficient extent, especially given the fact that we are not aware of many other studies that use administrative data in Italian context and quality of data is not always satisfying, even if increasing.