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Restructuring hospital industry to control public health care expenditure: The role of input substitutability
Authors:Massimiliano Piacenza  Gilberto Turati  Davide Vannoni
Institution:1. University of Torino, School of Economics, Department of Economics and Public Finance “G. Prato”, Corso Unione Sovietica 218 bis, 10134, Torino, Italy;2. HERMES, Center for Research on Regulated Services, Moncalieri (TO), Italy;3. Ceris-CNR, Institute for Economic Research on Firms and Growth, Moncalieri (TO), Italy;4. Catholic University of Milan, Institute of Economics and Public Finance, Milano, Italy
Abstract:In this paper we investigate the economic rationality of the bed downsizing process, characterising the hospital industry worldwide in the last decades, as a measure to control public health care expenditure. Considering a sample of Italian hospitals, we provide fresh evidence on the factor substitutability in the production of hospital services. Differently from other studies, based on North-American data and limited to pre-determined cost function models, we estimate a general specification (the Generalised Composite), and test it against traditional nested models (e.g. the Translog). For all the specifications we derive Allen, Morishima and Shadow elasticities of substitution between input pairs, obtaining a fairly consistent picture across all models and elasticity concepts. In particular, our results highlight a very limited degree of substitutability between factors in the production of hospital services, especially between beds and medical staff. These findings suggest that a restructuring policy of the hospital industry, which is confined to reducing the number of beds without involving workforce management, could not be a viable strategy for controlling public health care expenditure.
Keywords:D24  H51  I18  L32
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