Productivity and Technical Efficiency in the Italian Insurance Industry

The purpose of this paper is to partially fill the gap in the existing literature by conducting an analysis of technical efficiency and productivity growth in the Italian insurance industry. The analysis makes use of a detailed data base on Italian life and non-life insurance companies over the period 1985-1993, provided by the Associazione Nazaionale fra le Impress Assicurazioni, the association of insurance companies. The authors measure technical efficiency, changes in technical efficiency over time, and technical changes over time for a sample of Italian insurers, and use the results to test hypotheses regarding industrial organization and to analyze trends associated with structural developments in the market. Data development analysis (DEA) is used to estimate product frontiers for each year of the sample. A production frontier gives the minimum inputs required to produce any given output vector. An important reason for conducting the analysis presented is to provide benchmark statistics to facilitate comparisons of efficiency and productivity under the new European regulatory regime when data on more recent periods become available. In addition, the production frontier results are used to test hypotheses about two major issues in industrial organization - the coexistence of alternative product distribution systems, and organizational forms in an industry. The results indicated that technical efficiency in the Italian insurance industry ranged from 70 to 78 percent during the sample period. There was almost no efficiency change over the sample period. However, productivity declined significantly over the sample period, with a cumulative decline of about 25 percent. The decline was attributable almost exclusively to technological regress, implying that insurers needed more inputs to produce their outputs at the end of the sample period that they did at the beginning. Although improvement in both technical efficiency and technical change appear to be needed, the main problem at present appears to be the adverse shift in the production frontier. Although the sources of the technical regress characterizing the Italian industry are not entirely clear, this phenomenon has been observed in at least one other financial services industry that experienced deregulation and growth in new products and distribution systems - the Spanish savings banks. In a dynamically changing environment, many insurers may be adopting new approaches to producing their outputs. This provides more opportunities for firms to make mistakes in the choice of technology, perhaps leading to excessive consumption of inputs even by "best practice" firms. An increase in the complexity of insurance products and markets could have a similar effect. As firms become more experienced at operating in the new environment and the initial false-starts in the adoption of new technology have been corrected, the productivity of the Italian insurance industry can be expected to improve. The increase in competition resulting from deregulation should reinforce this process, as firms that fail to improve are likely to be penalized the by the market.

Telerehabilitation after total knee replacement in Italy: cost-effectiveness and cost-utility analysis of a mixed telerehabilitation-standard rehabilitation programme compared with usual care

OBJECTIVES: To assess cost-effectiveness and cost utility of telerehabilitation (TR) versus standard rehabilitation (SR) after total knee replacement (TKR). DESIGN: Markov decision modelling of cost-effectiveness and cost-utility analysis based on patient-level and secondary data sources employing Italian National Health Service (NHS; Ita-NHS) and Society perspectives. SETTING: Primary care units (PCUs) in Italy. PARTICIPANTS: Patients discharged after TKR. INTERVENTIONS: Mixed SR-TR service (10 face-to-face sessions and 10 telesessions) versus SR (20 face-to-face sessions) PRIMARY AND SECONDARY OUTCOME MEASURES: The incremental cost per additional knee flexion range of motion (ROM) and per QALY gained by SR-TR compared with SR. Second, we considered the probability of being cost-effective and the probability of being more effective and less expensive. RESULTS: TR appears to be the cost-effective in the base case and in all of the considered scenarios, but is no longer more effective and less expensive if transportation costs are excluded. Comparing SR-TR with SR, the incremental cost-effectiveness ratio (ICER) adopting the Ita-NHS perspective for the base case was −€117/ROM gained. The cost-effectiveness probability for SR-TR was 0.98 (ceiling ratio: €50/ROM), while the joint probability of being more effective and less expensive was 0.87. Assuming that TR would increase health-related quality of life (HRQOL) utilities by 2.5%, the ICER adopting Ita-NHS perspective is −€960/QALY (cost-effectiveness probability: 1; ceiling ratio: €30 000/QALY). All the performed sensitivity analyses did not change the conclusions, but if transportation costs were excluded, the probability for SR-TR of being more clinically effective and less expensive reduced to 0.56. CONCLUSIONS: The analysis suggested SR-TR to be cost-effective, even less expensive and more effective if the PCUs provide ambulance transportations. However, the uncertainty related to TR costs, HRQOL and long-term clinical outcomes raises important topics for future research, which should be addressed to confirm our estimates. TRIAL REGISTRATION NUMBER: ISRCTN45837371

Auctions vs. Bargaining: An Empirical Analysis of Medical Device Procurement

We test recent theory on the benefits of auctions and bargaining as alternative procurement mechanisms using data on the procurement of medical devices by Italian hospitals. Theory suggests that auctions perform well when cost control is the key concern, but are less effective at producing the optimal mix of quality and price for complex products where quality is difficult to verify. Consistent with the theory, we find that auctions are used more often when the influence of financial staff relative to medical staff is high, when the marginal cost of increasing product quality is high, and when the marginal value of increasing quality is low.-

Suspensory materials for surgery of blepharoptosis: a systematic review of observational studies

Background Frontalis suspension surgery is considered the procedure of choice in cases of blepharoptosis. Among all the materials used in this type of surgery, ophthalmic and plastic surgeons prefer to use autologous Fascia Lata. However, during years, other autogenous and exogenous materials have been introduced. Objectives The aim of this study was therefore that of systematically reviewing the functional results and the rate of complications of different synthetic materials, as compared to autogenous Fascia Lata. The primary objective was to determine the rates of Successful Surgeries (SSs) of these materials. The secondary objective was to assess the onset of complications. The following materials were investigated: Fascia Lata, Mersilene, polytetrafluoroethylene (PTFE) and Silicon. Data Source and Methods Following the Prisma procedure, on January 30th, 2016 we used the following electronic databases to select the studies: MEDLINE and Scopus. Results The search strategy retrieved 48 publications that met the eligibility criteria of the systematic review. All studies were non-comparative. PTFE (n = 5) showed the best rate of SSs among the materials compared (statistically significant). Surgeries performed with autogenous Fascia Lata (n = 19) had a 87% rate of success those performed with Mersilene (n = 12)had 92% and those performed with Silicon (n = 17)88%. PTFE had the best outcome, with 99% success rate. As for complications, surgeries performed with PTFE had a higher rate of suture infections (1.9%) as compared to Fascia Lata, but lower incidence for all other complications. Conclusions Although most studies were good quality cohort studies, the overall quality of this evidence should be regarded as low due to their non-comparative design. Our data suggest that PTFE seems to be the most valid alternative material for frontalis suspension surgery, with low recurrence rates and good cosmetic and functional results

Systemic lupus erythematosus and the economic perspective: a systematic literature review and points to consider

Systemic lupus erythematosus (SLE) is a chronic, disabling, progressive disease, with many associated comorbidities, affecting patients during prime working years resulting in a high economic burden on society, producing high direct, indirect and intangible costs. In this article, our goals are two-fold. First, we review and discuss studies published in the period 2002–2012 concerning costs of SLE and point out gaps in the published literature. Second, we propose further research studies to advance our understanding of the economic perspective in SLE in the current area of new and emerging therapies. The literature evaluating disease costs in SLE remains limited and to date has only included a small number of countries. Despite these limitations, available studies indicate that SLE has significant socio-economic ramifications. Future studies are needed, especially to assess novel biologic therapies which have been made available or currently under investigation for SLE. An interesting approach in these new economic evaluations in SLE may be represented by the selection of the targets of the treatment to include in the cost-effectiveness and cost-utility analyses. Future treat-to-target strategies will likely include evaluation of their pharmacoeconomic implications

Assessment of the Economic Impact of Belimumab for the Treatment of Systemic Lupus Erythematosus in the Italian Setting: A Cost-Effectiveness Analysis

OBJECTIVE: The purpose of this analysis is to evaluate the cost-effectiveness of belimumab, a new biological treatment specifically developed for the treatment of Systemic Lupus Erythematosus (SLE), in the Italian setting. SLE is a chronic non-organ specific autoimmune disease characterized by a disregulation of the immune system that involves many organs and systems. METHODS: A cost-effectiveness micro-simulation model with a lifetime horizon originally developed for the UK was adapted to the Italian setting. The analysis compared Standard of Care (SoC) alone vs belimumab plus SoC from a National Healthcare Service (NHS) and societal perspective. Health-economic consequences of treatments and organ damage progression were calculated. When available, Italian data were used, otherwise UK costs were converted using Purchasing Power Parities (PPPs). Utility values were based on the EQ-5D™ assessments in the belimumab clinical trials (BLISS 52 and 76). Results were discounted with 3% for costs and effects. A maximum belimumab treatment duration of 6 years was assumed and wastage costs were considered. RESULTS: Cost per life year gained (Incremental Cost-Effectiveness Ratio, ICER) and cost per Quality Adjusted Life Year (QALY) (Incremental Cost-Utility Ratio, ICUR) were €22,990 and €32,859, respectively. These values reduced to €20,119 and €28,754, respectively, when indirect costs were included. CONCLUSIONS: It may be concluded that in the Italian setting and according to the guidelines of the Italian Association of Health Economics (IAHE), belimumab was shown to be cost-effective, in terms of both ICER and ICUR, (€25-40,000/QALY)

Traumi oculari al pronto soccorso oculistico. Ricerca condotta presso la Clinica Oculistica del Policlinico Umberto I di Roma su 81.825 casi in 10 anni. La prevenzione è sempre fondamentale per evitare danni oculari.

Abstract Obiettivo Determinare gli esiti funzionali a distanza dei traumi oculari gravi contusivi e perforanti che hanno necessitato di intervento chirurgico. Metodi Studio retrospettivo, effettuato tra gennaio 2003 e marzo 2013, di 672 pazienti con macrotraumi oculari, giunti al Pronto Soccorso (PS) della Clinica Oculistica, Dipartimento di Oftalmologia del Policlinico Umberto I di Roma. In particolare abbiamo focalizzato l’attenzione sui pazienti con traumi oculari contusivi o “a bulbo chiuso” e perforanti (ferite, corpo estraneo intraoculare – CEIO –, scoppio del bulbo) o “a bulbo aperto”. Risultati Il numero degli accessi per trauma è stato di 81.825 in 10 anni, di cui 672 (0,82%) con un macrotrauma che ha necessitato di intervento medico e chirurgico. Più frequenti (445; 66,18%) i traumi contusivi rispetto ai perforanti (227; 33,82%). Dei perforanti, 105 (46,3%) hanno avuto uno scoppio del bulbo che, assieme ai CEIO (67; 29,7%), sono le principali cause di prognosi infausta per l’occhio traumatizzato. Tra le complicanze più frequenti ci sono state, in ordine, quelle corneali (abrasioni ecc.) (94,2%), l’ipoema (86,3%) e la commotio retinae (edema di Berlin, 85,8%). Gli esiti funzionali a 6 mesi sono variati da visus normale (≤10/10 e >6/10) in 441 pazienti (65,7%), fino a cecità assoluta (MM, PL, NPL) in 57 pazienti (8,3%). L’OTS (ocular trauma score) e la tempestività d’intervento sono risultati essere un indice prognostico importante. Conclusioni Gli esiti funzionali (acuità visiva finale)dei traumi oculari contusivi e perforanti sono incrementabili con l’adeguatezza e la tempestività dell’intervento chirurgico del trauma in sé e delle complicanze che possono presentarsi contemporaneamente o successivamente. I traumi costituiscono una delle principali cause di ipovisione o cecità monoculare nei soggetti giovani adulti