Essays in Applied Health Economics: Evidence on Health and Health Care in Italy and UK

This thesis is the result of my experience as a PhD student taking part in the Joint Doctoral Programme at the University of York and the University of Bologna. In my thesis I deal with topics that are of particular interest in Italy and in Great Britain. Chapter 2 focuses on the empirical test of the existence of the relationship between technological profiles and market structure claimed by Sutton’s theory (1991, 1998) in the specific economic framework of hospital care services provided by the Italian National Health Service (NHS). In order to test the empirical predictions by Sutton, we identify the relevant markets for hospital care services in Italy in terms of both product and geographic dimensions. In particular, the Elzinga and Hogarty (1978) approach has been applied to data on patients’ flows across Italian Provinces in order to derive the geographic dimension of each market. Our results provide evidence in favour of the empirical predictions of Sutton. Chapter 3 deals with the patient mobility in the Italian NHS. To analyse the determinants of patient mobility across Local Health Authorities, we estimate gravity equations in multiplicative form using a Poisson pseudo maximum likelihood method, as proposed by Santos-Silva and Tenreyro (2006). In particular, we focus on the scale effect played by the size of the pool of enrolees. In most of the cases our results are consistent with the predictions of the gravity model. Chapter 4 considers the effects of contractual and working conditions on selfassessed health and psychological well-being (derived from the General Health Questionnaire) using the British Household Panel Survey (BHPS). We consider two branches of the literature. One suggests that “atypical” contractual conditions have a significant impact on health while the other suggests that health is damaged by adverse working conditions. The main objective of our paper is to combine the two branches of the literature to assess the distinct effects of contractual and working conditions on health. The results suggest that both sets of conditions have some influence on health and psychological well-being of employees.

L'accertamento dei reati di guida in stato di ebbrezza e alterazione da droghe

La tesi affronta le questioni processuali connesse alla verifica dei reati di guida in stato di ebbrezza e di alterazione da droghe. La ricerca si sviluppa in tre direzioni. La prima parte studia la disciplina tedesca. L’analisi parte dalle norme sostanziali che definiscono le fattispecie incriminatrici contemplate dall’ordinamento osservato; s’interessa, poi, degli equilibri tra gli strumenti di captazione della prova utili ai reati in discorso ed il principio nemo tenetur se detegere (l’ estensione del diritto di difesa tedesco copre anche le prove reali e non prevede obblighi di collaborazione all’alcoltest). Prosegue, infine, con l’esame delle metodologie di acquisizione della prova, dall’etilometro agli screening per le droghe, sino al prelievo ematico coattivo, indispensabile per l’accertamento penale. La seconda sezione esamina gli artt. 186 e 187 del codice della strada italiano, alla luce del principio di libertà personale e del diritto a non autoincriminarsi. Particolarmente delicati gli equilibri rispetto a quest’ultimo: l’obbligatorietà di un atto potenzialmente autoaccusatorio è evitabile solo a pena di una severa sanzione. Occorre definire se il diritto di difesa copra anche il mero facere o garantisca il solo silenzio. Se si ammette, infatti, che il nemo tenetur sia applicabile anche alle prove reali, la collaborazione obbligatoria imposta al conducente è scelta incompatibile con il diritto di difesa: la disciplina italiana presenta, dunque, profili d’illegittimità costituzionale. La terza parte riguarda le problematiche processuali poste dai controlli stradali che emergono dall’analisi della giurisprudenza. Si affrontano, così, le diverse vicende della formazione della prova: ci si interroga sull’istituto processuale cui ricondurre gli accertamenti, sulle garanzie di cui goda il guidatore durante e dopo l’espletamento dell’atto, sulle eventuali sanzioni processuali derivanti da una violazione delle predette garanzie. Si esaminano, infine, le regole di apprezzamento della prova che guidano il giudice nella delicata fase valutativa.

Essays in policy evaluation

This dissertation consists of three empirical studies that aim at providing new evidence in the field of public policy evaluation. In particular, the first two chapters focus on the effects of the European cohesion policy, while the third chapter assesses the effectiveness of Italian labour market incentives in reducing long-term unemployment. The first study analyses the effect of EU funds on life satisfaction across European regions , under the assumption that projects financed by structural funds in the fields of employment, education, health and environment may affect the overall quality of life in recipient regions. Using regional data from the European Social Survey in 2002-2006, it resorts to a regression discontinuity design, where the discontinuity is provided by the institutional framework of the policy. The second study aims at estimating the impact of large transfers from a centralized authority to a local administration on the incidence of white collar crimes. It merges a unique dataset on crimes committed in Italian municipalities between 2007 and 2011 with information on the disbursement of EU structural funds in 2007-2013 programming period, employing an instrumental variable estimation strategy that exploits the variation in the electoral cycle at local level. The third study analyses the impact of an Italian labour market policy that allowed firms to cut their labour costs on open-ended job contracts when hiring long-term unemployed workers. It takes advantage of a unique dataset that draws information from the unemployment lists in Veneto region and it resorts to a regression discontinuity approach to estimate the effect of the policy on the job finding rate of long-term unemployed workers.