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Health Policy. 2013 Aug;111(3):273-89. doi: 10.1016/j.healthpol.2013.05.014. Epub 2013 Jul 2.

Reimbursement systems and quality of hospital care: an empirical analysis for Italy.

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  • 1Department of Economics and Business, University of Catania, Corso Italia 55, 95129 Catania, Italy.


There is an ongoing debate about the effect of different reimbursement systems on hospital performance and quality of care. The present paper aims at contributing to this literature by analysing the impact of different hospital payment schemes on patients' outcomes in Italy. The Italian National Health Service is, indeed, a particularly interesting case since it has been subject to a considerable decentralization process with wider responsibilities devolved to regional governments. Therefore, great variability exists in the way tariffs are used, as Regions have settled them in accordance with the characteristics of health care providers. An empirical analysis of the Italian hospital system is carried out using data from the National Program for Outcome Assessment on mortality and readmissions for Acute Myocardial Infarction (AMI), Congestive Heart Failure (CHF), stroke and Chronic Obstructive Pulmonary Diseases (COPD) in the years 2009-2010. The results show that hospitals operating in Regions where prospective payments are used more extensively are generally associated with better quality of care.


DRG; Decentralization; Prospective payment systems; Quality of hospital care

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