Biomedical subjects

Luigi Siciliani

Publications and source records attributed to Luigi Siciliani.

5 recordsLinked to original sources

PubMed2006

Selection of treatment under prospective payment systems in the hospital sector.

A model of contracting for hospital treatments is presented. For a given diagnosis of the patient, two treatments are available: a high-intensity (surgical) treatment and a low-intensity (medical) treatment. A purchaser (the National Health Service, public or private insurer) offers a contract to the provider (the hospital) to maximise the patients' benefit net of costs. We show that if the average severity of the patient is private information known only by the provider, the hospital has an incentive to over-provide the surgical treatment to the low-severity patients. The optimal contract with asymmetric information is such that hospitals that provide a higher share of surgical treatments receive a higher price for the surgical treatment and a lower price for the medical treatment. This situation differs from current remuneration systems in which the price for each type of treatment is uniform. A related result is that with asymmetric information the optimal contract involves a higher transfer than with symmetric information.

Algorithms↗

PubMed2006

A dynamic model of supply of elective surgery in the presence of waiting times and waiting lists.

This paper analyses hospitals' decisions regarding the supply of elective surgery in a dynamic model in the presence of waiting times and waiting lists. We show that periods of increasing (decreasing) supply and increasing (decreasing) waiting list may be optimal paths towards the steady state. We also analyse the hospitals' response to exogenous shocks on the demand and the supply. For example, an increase in the marginal tariff for the provider generates overshooting in the supply: supply jumps upwards when the shock is introduced and then slowly reduces towards the steady-state value.

Decision Making, Organizational↗

PubMed2006

Estimating technical efficiency in the hospital sector with panel data: a comparison of parametric and non-parametric techniques.

BACKGROUND: Policy makers are increasingly interested in developing performance indicators that measure hospital efficiency. These indicators may give the purchasers of health services an additional regulatory tool to contain health expenditure. OBJECTIVE: Using panel data, this study compares different parametric (econometric) and non-parametric (linear programming) techniques for the measurement of a hospital's technical efficiency. METHOD: This comparison was made using a sample of 17 Italian hospitals in the years 1996-9. RESULTS: Highest correlations are found in the efficiency scores between the non-parametric data envelopment analysis under the constant returns to scale assumption (DEA-CRS) and several parametric models. Correlation reduces markedly when using more flexible non-parametric specifications such as data envelopment analysis under the variable returns to scale assumption (DEA-VRS) and the free disposal hull (FDH) model. Correlation also generally reduces when moving from one output to two-output specifications. CONCLUSIONS: This analysis suggests that there is scope for developing performance indicators at hospital level using panel data, but it is important that extensive sensitivity analysis is carried out if purchasers wish to make use of these indicators in practice.

Cost Control↗

PubMed2005

Does more choice reduce waiting times?

This paper develops a model of the supply of elective treatments within a duopolistic market structure where patients can be referred to the hospital with the lowest waiting times. We investigate the effect of a higher degree of substitutability among the two hospitals on equilibrium supply, waiting time and the size of the waiting list. The degree of substitutability is interpreted as the degree of choice or the extent to which patients can switch from one hospital to the other. We show that the greater the degree of substitutability among hospitals, the lower is the supply and the higher the waiting time. The effect on waiting list size is ambiguous. This result holds either when the hospital is remunerated with a fixed budget or with activity-based funding. However, the reduction in supply and the increase in waiting time generated by higher substitutability are higher when hospitals are remunerated with fixed budgets. The main implication of the model is that, under certain assumptions, policies aimed at increasing provider choice may fail to reduce waiting times.

Choice Behavior↗

PubMed2005

Tackling excessive waiting times for elective surgery: a comparative analysis of policies in 12 OECD countries.

This paper compares policies to tackle excessive waiting times for elective surgery in 12 OECD countries. It is found that waiting times may be reduced by acting on the supply of or on the demand for surgery (or both). On the supply side, evidence suggests that both capacity and financial incentives towards productivity can play an important role. On the demand side, inducing a raising of clinical thresholds may reduce waiting times but may also provoke tension between clinicians and policy makers. Preliminary evidence also suggests that an increase in private health insurance coverage may reduce waiting times.

Data Collection↗