The impact of Community Health Centers on inappropriate use of emergency services.

Community Health Centers offer coordinated and comprehensive responses to primary care needs. Our study aims at assessing whether the introduction of such organizational model improved health outcomes measured by inappropriate emergency visits among diabetics in the Emilia-Romagna region of Italy. Using difference-in-differences methods within a staggered treatment setting, we estimate the effect of Community Health Center participation on inappropriate hospital emergency visits between year 2010 and year 2016.

Disease management in diabetes care: When involving GPs improves patient compliance and health outcomes.

Although the study of the association between interventions in primary care and health outcomes continues to produce mixed findings, programs designed to promote the greater compliance of General Practitioners and their diabetic patients with guidelines have been increasingly introduced worldwide, in an attempt to achieve better quality diabetes care through the enhanced standardisation of patient supervision. In this study, we use clinical data from the Diabetes Register of one large Local Health Authority (LHAs) in Italy's Emilia-Romagna Region for the period 2012-2015. Firstly, we investigate whether GPs' participation in the local Diabetes Management Program (DMP) leads to improved patient compliance with regional guidelines.

Spatial effects in hospital expenditures: A district level analysis.

We use spatial econometric methods to analyse spillovers in hospital expenditures across Health Districts of the Emilia-Romagna Region (Italy). We estimate spatial models that allow for global spillovers and distinguish between the expenditures associated with potentially inappropriate hospitalizations and those associated with complex medical procedures. We also investigate the relative contribution of geographical and institutional proximity in explaining spatial dependence, by explicitly modelling different connectivity structures and exploiting them to build alternative spatial weight matrices.

Price Changes in Regulated Healthcare Markets: Do Public Hospitals Respond and How?

This paper examines the behaviour of public hospitals in response to the average payment incentives created by price changes for patients classified in different diagnosis-related groups (DRGs). Using panel data on public hospitals located within the Italian region of Emilia-Romagna, we test whether a 1-year increase in DRG prices induced public hospitals to increase their volume of activity and whether a potential response is associated with changes in waiting times and/or length of stay. We find that public hospitals reacted to the policy change by increasing the number of patients with surgical treatments.

Does the extension of primary care practice opening hours reduce the use of emergency services?

Overcrowding in emergency departments generates potential inefficiencies. Using regional administrative data, we investigate the impact that an increase in the accessibility of primary care has on emergency visits in Italy. We consider two measures of avoidable emergency visits recorded at list level for each General Practitioner.

Dealing with minor illnesses: The link between primary care characteristics and Walk-in Centres' attendances.

The reformulation of existing boundaries between primary and secondary care, in order to shift selected services traditionally provided by Emergency Departments (EDs) to community-based alternatives, has determined a variety of organisational solutions. One innovative change has been the introduction of fast-track systems for minor injuries or illnesses, whereby community care providers are involved in order to divert patients away from EDs. These facilities offer an open-access service for patients not requiring hospital treatments, and may be staffed by nurses and/or primary care general practitioners operating within, or alongside, the ED.

The role of GP's compensation schemes in diabetes care: evidence from panel data.

We investigate the impact of the implementation of Diabetes Management Programs with financial incentives in the Italian Region Emilia-Romagna between 2003 and 2005. We focus on avoidable hospitalisations for diabetic patients for whom GPs receive additional payments exceeding capitation. We estimate a panel count data model to test the hypothesis that those patients under the responsibility of GPs receiving a higher share of their income through ad-hoc payments, are less likely to experience avoidable hospitalisations.

GPs and hospital expenditures. Should we keep expenditure containment programs alive?

Pay-for-Performance programs offering additional payments to GPs can be used not only to improve the quality of care but also for cost containment purposes. In this paper, we analyse the impact of removing financial incentives in primary care that were aimed at containing hospital expenditure in the Italian region of Emilia-Romagna during the period 2002-2004. Our analysis draws on regional databanks linking GPs' characteristics to those of their patients (including all sources of public payments made to GPs), together with information on the utilisation of hospital services.

Incentives in primary care and their impact on potentially avoidable hospital admissions.

Financial incentives in primary care have been introduced with the purpose of improving appropriateness of care and containing demand. We usually observe pay-for-performance programs, but alternatives, such as pay-for-participation in improvement activities and pay-for-compliance with clinical guidelines, have also been implemented. Here, we assess the influence of different programs that ensure extra payments to GPs for containing avoidable hospitalisations.

Economic incentives in general practice: the impact of pay-for-participation and pay-for-compliance programs on diabetes care.

Objectives: We investigate the impact on quality of care of the introduction of two financial incentives in primary care contracts in the Italian region Emilia Romagna: pay-for-participation and pay-for-compliance with best practices programs.

Methods: We concentrate on patients affected by diabetes mellitus type 2, for which the assumption of responsibility and the adoption of clinical guidelines are specifically rewarded. We test the hypothesis that, other things equal, patients under the responsibility of general practitioners (GPs) receiving a higher share of their income through these programs are less likely to experience hospitalisation for hyperglycaemic emergencies.

Eliciting the demand for long-term care coverage: a discrete choice modelling analysis.

We evaluate the demand for long-term care (LTC) insurance prospects in a stated preference context, by means of the results of a choice experiment carried out on a representative sample of the Emilia-Romagna population. In this paper, these methods are first of all used in order to assess the relative importance of the characteristics that define hypothetical insurance programmes and to elicit the willingness to pay for some LTC coverage prospects. Moreover, thanks to the application of a nested logit specification with 'partial degeneracy', we are able to model the determinants of the preference for status quo situations where no systematic cover for LTC exists.

The analysis of a cardiological network in a regulated setting: a spatial interaction approach.

We analyse referral patterns for patients undergoing percutaneous transluminal coronary angioplasty (PTCA) in the Emilia Romagna region of Italy, a procedure for which the assumption of a negative association between volume and adverse outcomes is used to justify its territorial concentration. Nevertheless, recent clinical evidence shows PTCA superiority for immediate treatment of acute myocardial infarction, which advises an increase in the number of points of delivery. Our paper aims to develop analytical tools designed to provide support to policy makers when they are asked to evaluate the spatial distribution of catheterisation laboratories that perform PTCA.