Administrative Border Effects in COVID-19 Related Mortality

IZA Discussion Paper Forthcoming

HEDG Discussion Paper Series

51 Pages Posted: 1 Dec 2021

See all articles by Paolo Berta

Paolo Berta

University of Milano-Bicocca; University of Milan - Bicocca

Massimiliano Bratti

Università degli Studi di Milano - DEAS; Institute for the Study of Labor (IZA)

Carlo V. Fiorio

University of Milan - Department of Economics, Management and Quantitative Methods (DEMM)

Enrico Pisoni

European Union - European Commission Joint Research Centre-Ispra

Stefano Verzillo

European Commission, Joint Research Centre

Date Written: November 13, 2021

Abstract

Does the organisation of healthcare systems affect health outcomes? To answer this question, we analysed the effects of the Covid-19 pandemic by focusing on mortality rate outcomes and exploited the heterogeneity of the healthcare organisational models among Italian regions, which makes Italy an ideal ”laboratory”. Within a common national healthcare system, Italian regions are allowed large autonomy to organise themselves as mixed-markets based on choice and competition, network or centralised leadership models, each delivering different responses to the Covid-19 emergency. Exploiting the discontinuity of healthcare organisational models across the Italian regional borders around Lombardy — the region that most convincingly embraced the mixed-market model fostering competition among health service providers — we applied a difference in geographic regression discontinuity design (DiD-GRDD) to compare mortality rates in 2020 of Lombardy’s municipalities with that of neighboring municipalities in other regions and also exploited the pre-crisis period (2017-2019). Our analysis shows that mortality rates in Lombardy during the first wave were higher by 1-2 percentage points among the population of residents aged 80 years or more, compared to the past, as opposed to regions adopting different organisational models. The mortality rate differential disappeared during the second wave following the implementation of a national policy based on risk zones, limiting mobility and taking stock of the experience developed during the first wave. Finally, by investigating the channels causing higher mortality during the first wave, we show that the role of organisational model differences vanishes, as differential mortality is mostly explained by the decision of the Lombardy regional government to use care homes for hosting Covid-19 patients and reduce the excess demand on the hospital system.

Note:
Funding: None to declare.

Declaration of Interests: None to declare.

Keywords: Covid-19 mortality administrative borders regions Italy

JEL Classification: I10, H12

Suggested Citation

Berta, Paolo and Bratti, Massimiliano and Fiorio, Carlo V. and Pisoni, Enrico and Verzillo, Stefano, Administrative Border Effects in COVID-19 Related Mortality (November 13, 2021). IZA Discussion Paper Forthcoming, HEDG Discussion Paper Series, Available at SSRN: https://ssrn.com/abstract=3962989 or http://dx.doi.org/10.2139/ssrn.3962989

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

Massimiliano Bratti

Università degli Studi di Milano - DEAS ( email )

Via Conservatorio, 7
I-20122 Milano
Italy

Institute for the Study of Labor (IZA)

P.O. Box 7240
Bonn, D-53072
Germany

Carlo V. Fiorio

University of Milan - Department of Economics, Management and Quantitative Methods (DEMM) ( email )

Via Conservatorio, 7
Milan, 20122
Italy

Enrico Pisoni

European Union - European Commission Joint Research Centre-Ispra ( email )

Via Fermi
Ispra, Varese 21027
Italy

Stefano Verzillo (Contact Author)

European Commission, Joint Research Centre ( email )

Via Fermi
Ispra, Varese 21027
Italy

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