Department of Economics and Business, University of Catania, Corso Italia 55, 95129 Catania, Italy.
Health Policy. 2013 Aug;111(3):273-89. doi: 10.1016/j.healthpol.2013.05.014. Epub 2013 Jul 2.
There is an ongoing debate about the effect of different reimbursement systems on hospital performance and quality of care. The present paper aims at contributing to this literature by analysing the impact of different hospital payment schemes on patients' outcomes in Italy. The Italian National Health Service is, indeed, a particularly interesting case since it has been subject to a considerable decentralization process with wider responsibilities devolved to regional governments. Therefore, great variability exists in the way tariffs are used, as Regions have settled them in accordance with the characteristics of health care providers. An empirical analysis of the Italian hospital system is carried out using data from the National Program for Outcome Assessment on mortality and readmissions for Acute Myocardial Infarction (AMI), Congestive Heart Failure (CHF), stroke and Chronic Obstructive Pulmonary Diseases (COPD) in the years 2009-2010. The results show that hospitals operating in Regions where prospective payments are used more extensively are generally associated with better quality of care.
关于不同报销制度对医院绩效和医疗质量的影响，一直存在争论。本文旨在通过分析意大利不同的医院支付方式对患者结局的影响，为这一文献做出贡献。意大利国家卫生服务体系确实是一个特别有趣的案例，因为它经历了相当大的权力下放过程，将更多的责任下放给了地区政府。因此，费率的使用方式存在很大差异，因为各地区根据医疗服务提供者的特点确定了费率。本文利用 2009-2010 年意大利国家急性心肌梗死（AMI）、充血性心力衰竭（CHF）、中风和慢性阻塞性肺疾病（COPD）死亡率和再入院情况国家预后评估计划的数据，对意大利医院系统进行了实证分析。结果表明，在更多使用预付款的地区运营的医院通常与更好的医疗质量相关。
