Larger is Better: The Scale Effects of the Italian Local Healthcare Authorities Amalgamation Program

Consolidation is often considered as a means to lower service delivery costs and enhance accountability. This paper uses a prospective evaluation design to derive estimates of the potential cost savings that may arise from Local Healthcare Authorities (LHAs) amalgamation process, which is concerning the Itali an National Health System. We focus specifically on cost savings due to scale economies with reference to a particular subset of the production costs of the LHAs, i.e. the administrative costs together with the purchasing costs of both goods as well as non-healthcare related services. Our results demonstrate the existence of economies of scale linked to the size of the LHA population. Hence, the decision to reduce the number of LHAs may result in larger local health authorities that are more cost efficient, especially when the consolidation process concerns merging a large number of LHA

Growth of winter flounder (Pseudopleuronectes americanus) and smooth flounder (Liopsetta putnami) in heated and unheated water

0-group and I-group winter (Pseudopleuronectes americanus) and smooth (Liopsetta putnami) flounder were reared at the Jackson Estuarine Laboratory, Durham, NH, U.S.A., between November 1975 and June 1976. Both species gained weight approximately three times more rapidly in heated than in unheated water. In unheated water the smallest winter flounder gained, on average, 116% of their body weight per month. Larger 0-group winter flounder increased body weight by 55% per month, while comparably sized female and male smooth flounder gained 52% and 28% per month, respectively. I-group female smooth flounder gained 9.5% and male smooth flounder 8.5% per month in heated water. In unheated water increases were 13%, 22%, and 14% per month for 0-group winter, female smooth, and male smooth flounder, respectively. I-group winter flounder in unheated water gained weight twice as rapidly (9.5% per month) as I-group female and male smooth flounder (4.0% and 4.5% per month, respectively). Fish were fed a moist diet at a level of 10% of their body weight per day. Conversions (dry weight of food/wet weight of fish) ranged from 1:1 for 0-group winter flounder in heated water to 27:1 for I-group smooth flounder in unheated water. Disease was a major cause of mortality. Vibrio anguillarum was confirmed as a pathogen; myxobacteria, and the protozoan parasites Kudoa sp. and Nosema sp. were associated with losses

Scale Effects and Expected Savings from Consolidation Policies of Italian Local Healthcare Authorities

Background: Consolidation is often considered by policymakers as a means to reduce service delivery costs and enhance accountability. Objective: The aim of this study was to estimate the potential cost savings that may be derived from consolidation of local health authorities (LHAs) with specific reference to the Italian setting. Methods: For our empirical analysis, we use data relating to the costs of the LHAs as reported in the 2012 LHAsâ\u80\u99 Income Statements published within the New Health Information System (NSIS) by the Ministry of Health. With respect to the previous literature on the consolidation of local health departments (LHDs), which is based on ex-post-assessments on what has been the impact of the consolidation of LHDs on health spending, we use an ex-ante-evaluation design and simulate the potential cost savings that may arise from the consolidation of LHAs. Results: Our results show the existence of economies of scale with reference to a particular subset of the production costs of LHAs, i.e. administrative costs together with the purchasing costs of goods (such as drugs and medical devices) as well as non-healthcare-related services. Conclusions: The research findings of our paper provide practical insight into the concerns and challenges of LHA consolidations and may have important implications for NHS organisation and for the containment of public healthcare expenditure