Does higher Institutional Quality improve the Appropriateness of Healthcare Provision?
Journal of Public Economics · 2021 · Giacomo De Luca、Domenico Lisi、Marco Martorana、Luigi Siciliani
中文摘要
本文研究制度质量对意大利医院医疗服务提供适当性的影响。我们聚焦于初产妇的剖宫产率,它是医疗服务适当性的常用指标,且易受医疗服务提供方机会主义行为的影响。为识别制度质量的因果效应,我们采用以历史工具为基础的工具变量(IV)策略,其思路是:各地区当前制度质量的差异是由不同的文化与政治历史塑造而成的。我们发现,制度质量指标增加一个标准差会使剖宫产率下降约10个百分点。本文结果对不同的制度质量衡量指标和不同样本均保持稳健。
Abstract
We study the effect of institutional quality on the appropriateness of healthcare provision in Italian hospitals. We focus on cesarean section rates for first-time mothers, which is a common indicator of appropriateness in healthcare and is vulnerable to providers’ opportunistic behaviors. To identify the causal effect of institutional quality we rely on an IV strategy based on historical instruments, exploiting the idea that current differences in institutional quality across regions have been shaped by different cultural and political histories. We find that a standard deviation increase in our indicator of institutional quality leads to a decrease of about 10 percentage points in cesarean section rates. Our results are robust to different measures of institutional quality and samples.