Job satisfaction among healthcare workers in the aftermath of the COVID-19 pandemic

: Using a unique survey of more than 7,000 respondents conducted immediately after the first wave of the COVID-19 pandemic in Italy, we investigate potential drivers of the job satisfaction of healthcare workers. Relying on a representative sample of Italian physicians and nurses, we show that, in addition to personal characteristics (e.g., age, gender, health status), contextual factors (i.e., working conditions) play the leading role in explaining variation in the level of satisfaction (58%). In particular, working in a high-quality facility increases worker satisfaction and willingness to remain in the profession, and in the current medical specialization, while working in a province with a perceived shortage of medical personnel yields the opposite result. Direct experience with COVID-19 (e.g., having tested positive) is not significantly correlated with the level of job satisfaction, which is instead significantly reduced by changes in the working conditions caused by the health emergency

Studi Empirici in Economia Sanitaria

Nonostante il ruolo rilevante del settore sanitario e il significativo ammontare di risorse investite, si riscontra un intenso dibattito circa le modalità ottimali di finanziarlo e governarlo. Nella mia tesi, esamino tre possibili fattori che possono interferire nel corretto funzionamento del sistema sanitario, riducendone la sua efficienza. L’obiettivo è quello di fornire risultati empirici e raccomandazioni di policy che possano contribuire a migliorare le conoscenze circa i meccanismi sottostanti il funzionamento di un settore così strategico. Nei primi due capitoli, vengono studiati possibili drivers, differenti dalle condizioni mediche, che possono influenzare la decisione dei professionisti tra trattamenti medici alternativi. In primo luogo, vado a valutare il ruolo degli incentivi economici che agiscono sui medici, stimando l’effetto di una policy che equalizza le tariffe DRG assegnate all’evento “parto”. In secondo luogo, approfondisco la discussione circa la possibilità per il lato della domanda (i.e., pazienti) di entrare nel processo di decisione tra trattamenti medici alternativi. Più precisamente, vado ad investigare i potenziali meccanismi di trasmissione dell’informazione tra pazienti e come questi possano spiegare differenze territoriali nell’uso del taglio cesareo. Il terzo capitolo è dedicato all’analisi dell’offerta locale di professionisti sanitari, dato che la disponibilità di personale qualificato è un elemento chiave nell’offerta di servizi di qualità. In accordo con la letteratura, trovo che gli incentivi economici sono una fonte di inefficienza nel settore sanitario, anche se essi non ricoprono un ruolo prevalente nello spiegare l’uso di trattamenti non necessari. Il lato della domanda, ampliamente inesplorato, sembra avere un alto potenziale di entrare e influenzare il processo decisionale, ampliando possibili inefficienze. In ultimo, la distribuzione geografica dei professionisti risulta essere sensibile ad interventi di policy che modificano le regole di assunzione e finanziamento del settore. Si evidenzia che aree più svantaggiate in termini di disponibilità di personale riportano inferiori livelli di salute pubblica.Notwithstanding the relevant role played by the healthcare sector and the significant amount of resources absorbed, there is an intense discussion over the optimal way of financing and managing it. In my dissertation I examine three possible factors that may interfere with the proper functioning of the health system, reducing its efficiency. The aim is to provide empirical results and policy-oriented recommendations, which may foster the understanding of the mechanisms behind such a strategic sector. In the first two chapters, I study possible drivers other than medical conditions that may affect the physician' decision between alternative treatments. First, I evaluate the role of financial incentives given to physicians, estimating the effect of a fee equalization policy which operates on the DRG reimbursement assigned to delivery events. Second, I discuss whether the demand side (i.e., patients' side) enter the decision process when alternative treatments are considered. More precisely, I investigate potential mechanisms of information transmission among patients in explaining territorial variations in the use of cesarean sections. The third chapter is devoted to the analysis of the local supply of healthcare workers, since the availability of qualified personnel is a key element in the provision of quality health services. All in all, in accordance with the literature, I found that financial incentives are a source of inefficiency, even if they do not play the lion share in explaining the use of unnecessary treatments. The demand side, largely unexplored, seems to have a high potential of entering and affecting the decision process, amplifying inefficiencies. Lastly, the geographic distribution of professional is proved to be sensible to policies changing recruitment and financing rules, with more disadvantaged locations in terms of availability of professionals reporting lower public health outcomes

Neighborhoods, Networks, and Delivery Methods

We examine the contribution of information transmission among pregnant women to geographic variation in C-sections in Lombardy, Italy. Defining networks as pregnant women living in the same municipality, we observe that if the incidence of C-sections within the woman's network is one standard deviation higher over the 12 months preceding delivery, then her probability of delivering by C-section is 0.007 percentage points (3%) higher. This result is mainly a network effect on Italian women, while it arises from both network and neighborhood effects on foreign women. Both groups respond to additional information, such as the incidence of C-section complications. The selection of pregnant women across hospitals does not uniquely explain our results, which are robust to alternative sample selections and specifications

Fee equalization and appropriate health care

Fee equalization in health care brings under a unique tariff several medical treatments, coded under different Diagnosis Related Groups (DRGs). The aim is to improve healthcare quality and efficiency by discouraging unnecessary, but better-paid, treatments. We evaluate its effectiveness on childbirth procedures to reduce overuse of c-sections by equalizing the DRGs for vaginal and cesarean deliveries. Using data from Italy and a difference-in-differences approach, we show that setting an equal fee decreased c-sections by 2.6%. This improved the appropriateness of medical decisions, with more low-risk mothers delivering naturally and no significant changes in the incidence of complications for vaginal deliveries. Our analysis supports the effectiveness of fee equalization in avoiding c-sections, but highlights the marginal role of financial incentives in driving c-section overuse. The observed drop was only temporary and in about a year the use of c-sections went back to the initial level. We found a greater reduction in lower quality, more capacity-constrained hospitals. Moreover, the effect is driven by districts where the availability of Ob-Gyn specialists is higher and where women are predominant in the gender composition of Ob-Gyn specialists

Pharmacological characterisation and autoradiographic localisation of a putative dopamine D3 receptor in the rat kidney.

The pharmacological profile and the microanatomical localisation of a putative dopamine D3 receptor in the rat renal cortex were investigated using radioligand binding assay and light microscope autoradiography techniques. [3H]7-hydroxy-N,N-di-n-propyl-2-aminotetraline ([3H]7-OH-DPAT) was used as a ligand. [3H]7-OH-DPAT was bound specifically to sections of renal cortex. The binding was time-, temperature- and concentration-dependent, of high affinity and guanine nucleotide-insensitive. The dissociation constant (Kd) value was 0.57 +/- 0.02 nM and the maximum density of binding sites (Bmax) was 62.4 +/- 3.5 fmol/mg tissue. The pharmacological profile of [3H]7-OH-DPAT binding to sections of rat renal cortex suggests the labelling of a dopamine D3 receptor. Light microscope autoradiography revealed the accumulation of the radioligand primarily within cortical tubules and to a lesser extent in the glomerular tuft. In glomeruli, binding sites were found mainly in mesangium and mesangial cells. The demonstration of a putative dopamine D3 receptor in slide-mounted sections of rat renal cortex suggests that appropriate radioligand binding assay techniques combined with autoradiography, may contribute to characterise peripheral dopamine receptor subtypes