An econometric analysis of the quality of hospital care in Italy: market characteristics and policy choices within Regions and Local Health Units (LHUs)

Hospital financing, in Italy, is governed through Diagnosis Related Groups (DRGs) reimbursement system. National legislation allows Regions to set autonomously their own tariffs; Regions can also decide other aspects of the hospital care, such as the public-private mix, the relationship among health policy authorities and providers, etc. All these arrangements are expected to impact on quality of hospital care. The aim of this study is that of clarifying which factors may affect quality, as measured by the National Program for Outcome Assessment (Programma Nazionale Valutazione Esiti – PNE). A truncated regression model has been applied. The variables used to represent quality, among those ones available within the PNE, include mortality and readmission rates for Acute Myocardial Infarction (AMI), Congestive Heart Failure (CHF), Stroke and Chronic Obstructive Pulmonary Disease (COPD). The results confirm the hypothesis that factors related to demand, supply and the reimbursement scheme may explain quality outcomes.