Departments of Economics, Management and Quantitative Methods, University of Milano, Milano, Italy.
Health Econ. 2021 May;30(5):1001-1014. doi: 10.1002/hec.4234. Epub 2021 Feb 27.
We aim to investigate the cost containment effects of the creation in 2005 of agencies specifically responsible for all technical and administrative services within the regional healthcare system of the Tuscany region of Italy. We seek to contribute to the existing literature on the centralization and decentralization of purchases and technical services by assessing the amount of savings produced by these agencies at the intermediate level between local authorities and hospitals and the regional administration. We use the balances of all Italian local health authorities and hospital trusts combined with the synthetic control procedure to create from a donor pool of untreated units a weighted average of observations resembling the exposed units before and after the policy change in 2005. The magnitude of the effect is significant as the creation of these agencies is estimated to have reduced expenditures on auxiliary goods and contracted services by 6% in the period from 2006-2014. Moreover, we find that the cost reduction is not associated with a decrease in the provision of healthcare services and procedures to the general population or in the quality or efficiency of the regional healthcare system itself.
我们旨在调查 2005 年成立专门负责意大利托斯卡纳地区区域医疗体系内所有技术和行政服务的机构对成本控制的影响。我们试图通过评估这些机构在地方当局和医院与区域行政部门之间的中间层次上产生的节省金额，为现有关于采购和技术服务集中化和分散化的文献做出贡献。我们使用所有意大利地方卫生当局和医院信托的余额，并结合综合控制程序，从未处理单位的捐赠池中创建一个加权平均值，类似于政策变更前后暴露单位的观察值（2005 年）。由于这些机构的创建估计在 2006-2014 年期间将辅助商品和合同服务的支出减少了 6%，因此该影响的规模是显著的。此外，我们发现成本降低与向普通民众提供医疗保健服务和程序的减少或区域医疗保健系统本身的质量或效率的降低无关。
