Department of Economics and Management, University of Pavia, via San Felice, 5/7, 27100, Pavia, Italy.
Health, Econometrics and Data Group, University of York, Heslington, York, UK.
Appl Health Econ Health Policy. 2018 Feb;16(1):107-122. doi: 10.1007/s40258-017-0359-1.
Consolidation is often considered by policymakers as a means to reduce service delivery costs and enhance accountability.
The aim of this study was to estimate the potential cost savings that may be derived from consolidation of local health authorities (LHAs) with specific reference to the Italian setting.
For our empirical analysis, we use data relating to the costs of the LHAs as reported in the 2012 LHAs' Income Statements published within the New Health Information System (NSIS) by the Ministry of Health. With respect to the previous literature on the consolidation of local health departments (LHDs), which is based on ex-post-assessments on what has been the impact of the consolidation of LHDs on health spending, we use an ex-ante-evaluation design and simulate the potential cost savings that may arise from the consolidation of LHAs.
Our results show the existence of economies of scale with reference to a particular subset of the production costs of LHAs, i.e. administrative costs together with the purchasing costs of goods (such as drugs and medical devices) as well as non-healthcare-related services.
The research findings of our paper provide practical insight into the concerns and challenges of LHA consolidations and may have important implications for NHS organisation and for the containment of public healthcare expenditure.
决策者通常认为整合是降低服务提供成本和提高问责制的一种手段。
本研究旨在估算通过整合地方卫生当局（LHA）可能获得的潜在成本节约，特别参考意大利的情况。
在我们的实证分析中，我们使用了卫生部在新卫生信息系统（NSIS）中公布的 2012 年 LHA 收入报表中报告的 LHA 成本数据。与先前关于地方卫生部门整合的文献相比，该文献基于对地方卫生部门整合对卫生支出影响的事后评估，我们采用了事前评估设计，并模拟了整合 LHA 可能带来的潜在成本节约。
我们的结果表明，在 LHA 的生产成本的一个特定子集方面存在规模经济，即行政成本以及商品（如药品和医疗器械）的采购成本以及非医疗相关服务的成本。
本文的研究结果为 LHA 整合的关注和挑战提供了实际的见解，并可能对 NH S 组织和公共医疗保健支出的控制具有重要意义。
