The effects of upcoding, cream skimming and readmissions on the Italian hospitals efficiency: a population–based investigation

In this paper we analyze the effects of some distortions induced by prospective payment system, i.e. Upcoding, Cream Skimming and Readmissions, on hospitals’ technical efficiency. We estimate a production function using a population–based dataset composed by all active hospitals in an Italian region during the period 1998–2007. We show that cream skimming and upcoding have a negative impact on hospitals’ technical efficiency, while readmissions have a positive effect. Moreover, we find that private hospitals are more engaged in cream skimming than public and not–for–profit ones, while we observe no ownership differences regarding upcoding. Not–for–profit hospitals have the highest readmission index. Last, not–for–profit and public hospitals have the same efficiency levels, while private hospitals have the lowest technical efficiency.Upcoding, Cream Skimming, Readmission, Hospital Technical Efficiency, Ownership.

The effects of upcoding, cream skimming and readmissions on the Italian hospitals efficiency: a population–based investigation

In this paper we analyze the effects of some distortions induced by prospective payment system, i.e. Upcoding, Cream Skimming and Readmissions, on hospitals’ technical efficiency. We estimate a production function using a population–based dataset composed by all active hospitals in an Italian region during the period 1998–2007. We show that cream skimming and upcoding have a negative impact on hospitals’ technical efficiency, while readmissions have a positive effect. Moreover, we find that private hospitals are more engaged in cream skimming than public and not–for–profit ones, while we observe no ownership differences regarding upcoding. Not–for–profit hospitals have the highest readmission index. Last, not–for–profit and public hospitals have the same efficiency levels, while private hospitals have the lowest technical efficiency

Food choice determinants and perceptions of a healthy diet among Italian consumers

Healthy food choices are crucial for a healthy lifestyle. However, food choices are complex and affected by various factors. Understanding the determinant factors affecting food choices could aid policy-makers in designing better strategies to promote healthy food choices in the general public. This study aims to evaluate the food choice motivations and to segment consumer groups, according to their food choice motivations, in a sample of 531 Italian consumers (collected by convenience sampling), through offline and online survey platforms. K-means cluster analysis was applied to identify consumer groups using six food choice motivation categories (health, emotional, economic and availability, social and cultural, environmental and political, and marketing and commercial). The results suggest that the strongest determinants for the food choices of Italian consumers are Environmental factors and Health. Two consumer profiles were identified through the segmentation analysis: Emotional eating and Health-driven consumers. The respondents were found to have a good awareness of what comprises a healthy diet. There is a potential market for healthy and sustainable food products, especially products with minimal or environmentally friendly packages. Food labels and information strategies could be promoted as tools to assist consumers to make healthy food choices

Highly site-specific H2 adsorption on vicinal Si(001) surfaces

Experimental and theoretical results for the dissociative adsorption of H_2 on vicinal Si(001) surfaces are presented. Using optical second-harmonic generation, sticking probabilities at the step sites are found to exceed those on the terraces by up to six orders of magnitude. Density functional theory calculations indicate the presence of direct adsorption pathways for monohydride formation but with a dramatically lowered barrier for step adsorption due to an efficient rehybridization of dangling orbitals.Comment: 5 pages, 4 figures, submitted to Phys. Rev. Lett. (1998). Other related publications can be found at http://www.fhi-berlin.mpg.de/th/paper.htm

Density-functional study of hydrogen chemisorption on vicinal Si(001) surfaces

Relaxed atomic geometries and chemisorption energies have been calculated for the dissociative adsorption of molecular hydrogen on vicinal Si(001) surfaces. We employ density-functional theory, together with a pseudopotential for Si, and apply the generalized gradient approximation by Perdew and Wang to the exchange-correlation functional. We find the double-atomic-height rebonded D_B step, which is known to be stable on the clean surface, to remain stable on partially hydrogen-covered surfaces. The H atoms preferentially bind to the Si atoms at the rebonded step edge, with a chemisorption energy difference with respect to the terrace sites of >sim 0.1 eV. A surface with rebonded single atomic height S_A and S_B steps gives very similar results. The interaction between H-Si-Si-H mono-hydride units is shown to be unimportant for the calculation of the step-edge hydrogen-occupation. Our results confirm the interpretation and results of the recent H_2 adsorption experiments on vicinal Si surfaces by Raschke and Hoefer described in the preceding paper.Comment: 13 pages, 8 figures, submitted to Phys. Rev. B. Other related publications can be found at http://www.rz-berlin.mpg.de/th/paper.htm

Magneli-like phases in epitaxial anatase TiO2 thin films

Using high-resolution transmission electron microscopy and image simulation techniques in combination with ab initio calculations, we show the existence of two different superlattices of crystallographic shear planes, analogous to the Magn\ue9li phases of rutile, in oxygen-deficient films of anatase TiO2 epitaxially grown on LaAlO3 substrates. (103)- and (101)-oriented shear plane structures are detected in the outer film region and in proximity of the film/substrate interface, respectively. We show that these shear planes are characterized by TiO-like cubic local structures, which can deviate from the TinO2n 121 stoichiometry of the classical rutile-derived Magn\ue9li phases, particularly in the outer part of the film. Computed formation energies provide insights into the thermodynamic stability of the observed structures and their relations to the growth dynamics

The CRACK programme: a scientific alliance for bridging healthcare research and public health policies in Italy

Healthcare utilisation databases, and other secondary data sources, have been used with growing frequency to assess health outcomes and healthcare interventions worldwide. Their increased popularity as a research tool is due to their timely availability, the large patient populations covered, low cost, and applicability for studying real-world clinical practice. Despite the need to measure Italian National Health Service performance both at regional and national levels, the wealth of good quality electronic data and the high standards of scientific research in this field, healthcare research and public health policies seem to progress along orthogonal dimensions in Italy. The main barriers to the development of evidence-based public health include the lack of understanding of evidence-based methodologies by policy makers, and of involvement of researchers in the policy process. The CRACK programme was launched by some academics from the Lombardy Region. By extensively using electronically stored data, epidemiologists, biostatisticians, pharmacologists and clinicians applied methods and evidence to several issues of healthcare research. The CRACK programme was based on their intention to remove barriers that thwart the process of bridging methods and findings from scientific journals to public health practice. This paper briefly describes aim, articulation and management of the CRACK programme, and discusses why it might find articulated application in Italy