Davide Golinelli1,2, Fabrizio Toscano3, Andrea Bucci4, Jacopo Lenzi2, Maria Pia Fantini2, Nicola Nante5, Gabriele Messina5. 1. Post-Graduate School of Public Health, Department of Molecular and Developmental Medicine, University of Siena, Via A. Moro 2, 53100, Siena, Italy. 2. Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy. 3. Post-Graduate School of Public Health, Department of Molecular and Developmental Medicine, University of Siena, Via A. Moro 2, 53100, Siena, Italy. ftoscanomd@gmail.com. 4. Department of Economics and Social Sciences, Marche Polytechnic University, Ancona, Italy. 5. Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
Abstract
BACKGROUND: The sustainability of healthcare systems is a topic of major interest. During periods of economic instability, policy makers typically reallocate resources and execute linear cuts in different areas of public spending, including healthcare. OBJECTIVES: The aim of this paper was to examine whether and how per capita public healthcare expenditure (PHE) in the Italian regions was related to the all-cause mortality rate (MR) between 1999 and 2013 and to determine which expenditure item most affected mortality in the short and very short term. METHODS: We conducted a pooled cross-sectional time series study. Secondary data were extracted from 'Health for All', a database released periodically by the Italian National Institute of Statistics. PHE is subdivided into directly provided services (DPS), pharmaceutical care, general practitioner care, specialist medical care, privately delivered hospital care, other privately delivered medical services, and psychiatric support and rehabilitation. We used a fixed-effects regression to assess the effects of PHE items on the MR after controlling for a number of socioeconomic and supply variables. RESULTS: Higher spending on DPS was associated with a lower MR. Other expenditure variables were not significantly associated with the MR. CONCLUSIONS: The results highlight the importance of medical services and goods provided directly by public services (i.e. hospital-based general and specialized wards and offices, emergency departments, etc.). DPS represents the driving force of the system and should be considered a determinant of the health of the Italian population. Our results suggest that the context and financing methods of a healthcare system should be carefully analysed before linear cuts are made or resources are reallocated.
BACKGROUND: The sustainability of healthcare systems is a topic of major interest. During periods of economic instability, policy makers typically reallocate resources and execute linear cuts in different areas of public spending, including healthcare. OBJECTIVES: The aim of this paper was to examine whether and how per capita public healthcare expenditure (PHE) in the Italian regions was related to the all-cause mortality rate (MR) between 1999 and 2013 and to determine which expenditure item most affected mortality in the short and very short term. METHODS: We conducted a pooled cross-sectional time series study. Secondary data were extracted from 'Health for All', a database released periodically by the Italian National Institute of Statistics. PHE is subdivided into directly provided services (DPS), pharmaceutical care, general practitioner care, specialist medical care, privately delivered hospital care, other privately delivered medical services, and psychiatric support and rehabilitation. We used a fixed-effects regression to assess the effects of PHE items on the MR after controlling for a number of socioeconomic and supply variables. RESULTS: Higher spending on DPS was associated with a lower MR. Other expenditure variables were not significantly associated with the MR. CONCLUSIONS: The results highlight the importance of medical services and goods provided directly by public services (i.e. hospital-based general and specialized wards and offices, emergency departments, etc.). DPS represents the driving force of the system and should be considered a determinant of the health of the Italian population. Our results suggest that the context and financing methods of a healthcare system should be carefully analysed before linear cuts are made or resources are reallocated.
Authors: Davide Golinelli; Andrea Bucci; Fabrizio Toscano; Filippo Filicori; Maria Pia Fantini Journal: BMC Health Serv Res Date: 2018-08-29 Impact factor: 2.655
Authors: Ana Rosa Rubio-Salvador; Vicente Escudero-Vilaplana; José Antonio Marcos Rodríguez; Irene Mangues-Bafalluy; Beatriz Bernárdez Ferrán; Carlos García Collado; Roberto Collado-Borrell; María Dolores Alvarado Fernández; José Ignacio Chacón López-Muñiz; María Yébenes Cortés; Manuel Gómez Barrera; Miguel Ángel Calleja-Hernández Journal: Int J Environ Res Public Health Date: 2021-01-06 Impact factor: 3.390