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AMS Acta (8,910 recursos)
Repository of the University of Bologna.

Settori scientifico-disciplinari MIUR = Area 13 - Scienze economiche e statistiche: SECS-P/03 Scienza delle finanze

Mostrando recursos 1 - 20 de 33

1. The role of GP’s compensation schemes in diabetes care: evidence from panel data - Iezzi, Elisa; Lippi Bruni, Matteo; Ugolini, Cristina
The design of incentive schemes that improve quality of care is a central issue for the healthcare sector. Nowadays we observe many pay-for-performance programs, where payment is contingent on meeting indicators of provider effort, but also other alternative strategies have been introduced, for example programs rewarding physicians for participation in diseases management plans. Although it has been recognised that incentive-based remuneration schemes can have an impact on GP behaviour, there is still weak empirical evidence on the extent to which such programs influence health outcomes. We investigate the impact of financial incentives in Regional and Local Health Authority contracts for...

2. Opt out or Top up? Voluntary Healthcare Insurance and the Public vs. Private Substitution - Fabbri, Daniele; Monfardini, Chiara
We investigate whether people enrolled into voluntary health insurance (VHI) substitute public consumption with private (opt out) or just enlarge their private consumption, without reducing reliance upon public provisions (top up). We study the case of Italy, where a mixed insurance system is in place. To this purpose, we specify a joint model for public and private specialist visits counts, and allow for different degrees of endogenous supplementary insurance coverage, looking at the insurance coverage as driven by a trinomial choice process. We disentangle the effect of income and wealth by going through two channels: the direct impact on the...

3. The strengths and failures of incentive mechanisms in notional defined contribution pension systems - Marano, Angelo; Mazzaferro, Carlo; Morciano, Marcello
Public pension systems based on the Notional Defined Contribution (NDC) principle were introduced during the ‘90s in Italy, Sweden and Poland, among other countries. They mimic private savings, in that individuals get back, as pensioners, what they contributed to social security during working life, plus returns. As such, NDC systems should realize actuarial equity and incentive neutrality. However, when one considers the presence of NDC pensions together with minimum and social assistance pensions, this is no longer true. Indeed, in all the three countries considered, the NDC system shows a regressive feature, which disincentives contributions, particularly from low earners, who...

4. Optimal Liability Design Under Risk and Ambiguity - Franzoni, Luigi Alberto
This paper develops an original mean-variance model able to capture the disposition of the parties towards both standard risk and ambiguity. Ambiguity arises when the causal link between conduct and harm is not univocal, as is frequently the case with toxic torts. Risk aversion and ambiguity aversion tend to have a similar impact on optimal liability rules if greater care reduces the ambiguity perceived by the parties, i.e. if safety and predictability go hand in hand. Strict liability dominates negligence when the injurer has lower degrees of risk and ambiguity aversion than the victim and can formulate less ambiguous estimates...

5. Price Changes in Regulated Healthcare Markets: Do Public Hospitals Respond and How? - Verzulli, Rossella; Fiorentini, Gianluca; Lippi Bruni, Matteo; Ugolini, Cristina
This paper examines the behaviour of public hospitals in response to the average payment incentives created by price changes for patients classified in different Diagnosis Related Groups (DRGs). Using panel data on public hospitals located within the Italian region of Emilia-Romagna, we test whether a one-year increase in DRG prices induced public hospitals to increase their volume of activity, and whether a potential response is associated with changes in waiting times and/or length of stay. We find that public hospitals reacted to the policy change by increasing the number of patients with surgical treatments. This effect was smaller in the two years after the policy change than...

6. Spatial effects in hospital expenditures: a district level analysis - Lippi Bruni, Matteo; Mammi, Irene
Geographical clusters in health expenditures are well documented and accounting for spatial interactions may contribute to properly identify the factors affecting the use of health services the most. As for hospital care, spillovers may derive from strategic behaviour of hospitals and from patients’ preferences that may induce mobility across jurisdictions, as well as from geographically-concentrated risk factors, knowledge transfer and interactions between different layers of care. Our paper focuses on a largely overlooked potential source of spillovers in hospital expenditure: the heterogeneity of primary care providers’ behaviour. To do so, we analyse expenditures associated to avoidable hospitalisations separately from expenditures for highly complex treatments, as the...

7. The optimal scope of trade secrets law - Franzoni, Luigi Alberto; Kaushik, Arun Kumar
The paper investigates the optimal scope of trade secrets law. In the model, one innovative firm invests resources first to produce knowledge, and then to protect it from unwanted disclosure. A rival firm invests to ferret out this knowledge. Trade secrets law affects this "secrecy contest" by reducing the probability of unwanted disclosure given the efforts of the parties. We show how optimal trade secrets policy depends on structural market features and cost parameters. In the final section, we consider the limit case in which the innovation lies on the face of the product, and derive the optimal scope of...

8. GPs and hospital expenditures. Should we keep expenditure containment programs alive? - Fiorentini, Gianluca; Lippi Bruni, Matteo; Ugolini, Cristina
Pay-for-performance programs offering additional payments to GPs can be used not only to improve the quality of care but also for cost containment purposes. In this paper, we analyse the impact of removing financial incentives in primary care that were aimed at containing hospital expenditure in the Italian region of Emilia Romagna during the period 2002-04. Our analysis draws on regional databanks linking GPs’ characteristics to those of their patients (including all sources of public payments made to GPs), together with information on the utilisation of hospital services. We employ a difference-in-difference specification to assess changes in expenditures for avoidable and total...

9. Does the extension of primary care practice opening hours reduce the use of emergency services? - Lippi Bruni, Matteo; Mammi, Irene; Ugolini, Cristina
Over-crowding in Emergency Departments (EDs) generates potential inefficiencies. Using regional administrative data, we investigate the impact of an increase in the accessibility of primary care on ED visits in Italy. We test whether extending practice opening hours up to 12 hours/day reduces inappropriate ED visits. We estimate count data models, considering different measures for ED visits recorded at the list level. Since the extension programme is voluntary, we also account for the potential endogeneity of participation, using a two-stage residual inclusion and a GMM approach. Our results show that improving primary care accessibility favours a more appropriate use of EDs.

10. A Top Dog Tale with Preference Rigidities - Randon, Emanuela; Simmons, Peter
With preference rigidities we find Pareto optima of an exchange economy, some of which involve unconsumed endowments. We show that such Pareto Optima can only be attained as market equilibria if there is a top dog in the initial endowment distribution who is richer than the other individuals. The most inegalitarian efficient allocation favouring the top dog is globally stable and is in the core. For endowment distributions with a top dog, the core contains efficient allocations more equal than the market equilibrium. A voting mechanism or government policy can also offset the top dog’s power.

11. Measuring Consumption Externalities - Randon, Emanuela
Estimation and measurement of consumption externalities are still challenging problems in applied research. In this paper, externalities as Nash equilibrium are estimated using consumer demand theory and a large data set. We estimate Nash equilibrium consumption externalities in petrol budget shares of households living in a metropolitan area in UK. The reaction curves are derived from an Almost Ideal Demand System (AIDS) with externalities. A continuous set of ten year cross sections from the Family Expenditure Surveys is used. In each year, income decile cohorts are created. Results of 2SLS with Panel Data are presented after 2SLS estimates with pooling cross...

12. La responsiveness dei sistemi sanitari: un’analisi empirica sull’assistenza ospedaliera nel Servizio Sanitario Regionale dell’Emilia Romagna - Robone, Silvana; Fiorentini, Gianluca; Nicoli, M. Augusta; Stefania, Rodella
The release of the World Health Report 2000 has brought to the fore the concept of responsiveness as an indicator of health system performance. Responsiveness relates to a system’s ability to respond to the legitimate expectations of potential users about non-health enhancing aspects of care (Valentine et al. 2003). A few studies have investigated how standard socio-demographic characteristics (such as income or education) have an influence on the evaluation of responsiveness by health care users (Puentes Rosas et al. 2006, Sirven et al. 2012, Rice et al. 2012). However, we are not aware of any study investigating the relationship between the...

13. Are bad health and pain making us grumpy? An empirical evaluation of reporting heterogeneity in rating health system responsiveness - Fiorentini, Gianluca; Ragazzi, Giovanni; Robone, Silvana
This paper considers the influence of patients’ characteristics on their evaluation of a health system’s responsiveness, that is, a system’s ability to respond to the legitimate expectations of potential users regarding non-health enhancing aspects of care (Valentine et al. 2003a). Since responsiveness is evaluated by patients on a categorical scale, their selfevaluation can be affected by the phenomenon of reporting heterogeneity (Rice et al. 2012). A few studies have investigated how standard socio-demographic characteristics influence the reporting style of health care users with regard to the question of the health system’s responsiveness (Sirven et al. 2012, Rice et al. 2012). However,...

14. Dealing with minor illnesses: the link between primary care characteristics and First Aid Clinics’ attendancesA - Donatini, Andrea; Fiorentini, Gianluca; Lippi Bruni, Matteo; Mammi, Irene; Ugolini, Cristina
The reformulation of existing boundaries between primary and secondary care, in order to shift selected services traditionally provided by Emergency Departments to community-based alternatives has determined a variety of organisational solutions aimed at reducing the ED overcrowding. One innovative change has been the introduction of fast-track systems for minor injuries or illnesses, whereby community care providers are involved in order to divert patients away from EDs. These facilities offer an open-access service for patients not requiring hospital treatments, and may be staffed by nurses and/or primary care general practitioners operating within, or alongside, the ED. To date little research has...

15. Delegating home care for the elderly to external caregivers? An empirical study on Italian data - Lippi Bruni, Matteo; Ugolini, Cristina
We study care arrangement decisions in Italy, where families are increasingly delegating the role of primary caregiver to external (paid) people also for the provision of home care. We consider a sample of households with a dependent elderly person cared for either at home or in a residential home, extracted from a survey representative of the population of Italy’s Emilia-Romagna region. We investigate the determinants of a household’s decision to opt for one of the following three alternatives: the institutionalisation of elderly family members, informal home care, or paid home care. We estimate two model specifications, based on a simultaneous...

16. Scritti scelti (Economia Politica e Scienza delle Finanze) - Luciani, Nino
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17. Measuring Consumption Externalities - Randon, Emanuela
Estimation and measurement of consumption externalities are still challenging problems in applied research. In this paper, externalities as Nash equilibrium are estimated using consumer demand theory and a large data set. We estimate Nash equilibrium consumption externalities in petrol budget shares of households living in a metropolitan area in UK. The reaction curves are derived from an Almost Ideal Demand System (AIDS) with externalities. A continuous set of ten year cross sections from the Family Expenditure Surveys is used. In each year, income decile cohorts are created. Results of 2SLS with Panel Data are presented after 2SLS estimates with pooling cross...

18. Efficient Allocations, Equilibria and Stability in Scarf's Economy - Randon, Emanuela; Simmons, Peter
Scarf's economy has been a vehicle in understanding stability properties in exchange economies. The full set of market equilibria and Pareto optimal allocations for this economy has not been analysed. This paper aims to do that. Firstly, we examine the Pareto optima and we and three different classes. Only Class I exhausts the aggregate endowments of all the goods. Class II and III involve throwing away partially or totally one good in order to achieve Pareto efficiency. Secondly, we explore the price and endowment distribution combinations which sustain the different Pareto Optima as market equilibria. A Pareto optimum which involves throwing away the whole endowment of...

19. A Top Dog Tale with Preference Rigidities - Randon, Emanuela; Simmons, Peter
With preference rigidities we find Pareto optima of an exchange economy, some of which involve unconsumed endowments. We show that such Pareto Optima can only be attained as market equilibria if there is a top dog in the initial endowment distribution who is richer than the other individuals. The most inegalitarian efficient allocation favouring the top dog is globally stable and is in the core. For endowment distributions with a top dog, the core contains efficient allocations more equal than the market equilibrium. A voting mechanism or government policy can also offset the top dog’s power.

20. L’imposta sul valore aggiunto: regime ordinario e regime del margine a confronto. Il caso del mercato dell’arte - Candela, Guido; Randon, Emanuela; Scorcu, Antonello E.
In letteratura, il confronto tra i metodi di calcolo dell’imposta sul valore aggiunto (regime ordinario e regime del margine) è limitato: si riduce al risultato di equivalenza ottenuto con aliquote identiche e uniformi nelle diverse fasi della produzione e dello scambio. In questo lavoro proponiamo un’analisi comparativa generale per stabilire la desiderabilità di un metodo rispetto all’altro in relazione alla struttura delle aliquote, alla tipologia dei soggetti coinvolti, alle politiche di commercializzazione. I risultati sono applicati per valutare il meccanismo di formazione dei prezzi nel mercato dell’arte. Si propongono degli interventi di riforma per rendere il regime fiscale neutrale e trasparente, incentivando scambi e investimenti.

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