The Dark Side of Fiscal Federalism: Evidence from Hospital Care in Italy

27 Pages Posted: 6 Sep 2018

See all articles by Paolo Berta

Paolo Berta

University of Milano-Bicocca; University of Milan - Bicocca

Carla Guerriero

CSEF - University of Naples Federico II - Department of Economic and Statistical Sciences

Rosella Levaggi

University of Brescia - Department of Economics and Management

Date Written: August 27, 2018

Abstract

We use 2009-14 data from patients hospital discharges to assess the effects of fiscal federalism on the quality of care provided to regional and extraregional patients in Lombardy. Empirical results suggest that even after controlling for hospital fixed effects, patients demographic and health characteristics, extraregional patients wait less compared to regional ones, stay longer in hospital and are associated with higher reimbursement costs. However, private and public hospitals with higher proportion of extraregional patients show a lower mortality and lower reimbursement costs. This result suggest that competition works because of the spillovers effects that the market for extraregional patients produces.

Keywords: hospital competition, patients mobility, mixed market, fiscal federalism

JEL Classification: H51, H77, D6, C70

Suggested Citation

Berta, Paolo and Guerriero, Carla and Levaggi, Rosella, The Dark Side of Fiscal Federalism: Evidence from Hospital Care in Italy (August 27, 2018). Available at SSRN: https://ssrn.com/abstract=3239398 or http://dx.doi.org/10.2139/ssrn.3239398

Paolo Berta

University of Milano-Bicocca ( email )

Piazza dell’Ateneo Nuovo 1, 20126 Milano
Milano, 20126
Italy

University of Milan - Bicocca ( email )

Via Bicocca degli Arcimboldi, 8
Milano, Milano 20126
Italy

Carla Guerriero

CSEF - University of Naples Federico II - Department of Economic and Statistical Sciences ( email )

Via Cintia 26
Napoli
Italy

Rosella Levaggi (Contact Author)

University of Brescia - Department of Economics and Management ( email )

Via San Faustino 74B
Brescia, 25122
Italy
+39 03 0298 8825 (Phone)
+39 03 0298 8837 (Fax)

HOME PAGE: http://www.eco.unibs.it/segdse/rlev/index.htm

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