Special issue on health economics and policy: Guest editors' introduction
介绍了健康经济学特刊的10篇论文，涵盖医院效率、等待时间、长期护理等主题，为政策制定者和研究者提供实证分析参考。
This issue of Health Economics features a range of rigorous econometric analyses which can inform health policy design and development. It provides a selection of papers presented at the V Health Econometrics Workshop held on July 22–24, 2016, at the University of Bari “Aldo Moro” (Italy). The workshop was funded and organized by the Inter-University Research Centre on Public Services at the University of Milan-Bicocca (Italy), University of Bergamo (Italy), and University Brunel London (UK), in conjunction with the University of Bari “Aldo Moro” that acted as the local organizer of the event. In the spirit of initiatives such as the Annual Health Econometrics Workshop and the European Workshop on Econometrics and Health Economics, the purpose of this biannual meeting is to provide a forum where policy makers, economists, and econometricians discuss the use of statistical and econometric methods to address issues in health economics. The theme of the V Health Econometrics Workshop was “Health Economics and Policy.” The workshop and special issue invited empirical (applied econometrics) papers that (a) evaluate current or past health policies; (b) undertake analyses which shed light on important health policy questions. This issue presents 10 contributions which cover a wide variety of topics in health economics and went through the usual refereeing process of the Journal. Central and local governments in Western countries have implemented a range of reforms in the health care sector with the ubiquitous goals of improving quality and efficiency of the health systems. The key areas of policy interventions are primary (GP) care, secondary (hospital) care, and long-term care. Several studies in this special issue are devoted at understanding drivers of different aspects of quality and efficiency in secondary care. Colombi et al. investigate the determinants of hospital efficiency in Italy. They find that transient (short-term) efficiency is relatively more important than persistent (long-term) efficiency, since it accounts for 60% of the total, and that ownership, specialization, and size are determinants of both types of inefficiency. Di Giacomo et al. study whether changes in Diagnosis-Related Group price regulation affect the behavior of public hospitals, as measured by C-section rates and upcoding. They find that price changes do not affect the probability of a C-section, but there is evidence of upcoding. Longo et al. investigate whether hospitals in the English National Health Service change their quality or efficiency in response to changes in quality or efficiency of neighboring hospitals. They find that although quality and efficiency measures are unconditionally spatially correlated, the spatial regression models suggest that a hospital's quality or efficiency does not respond to its rivals quality or efficiency, except for a hospital's overall mortality. Lippi Bruni and Mammi analyze spillovers in hospital expenditures across health districts and distinguish between expenditures associated with potentially inappropriate hospitalizations and those associated with complex medical procedures. They find that spillovers largely differ across types of expenditures, with positive spillovers for potentially inappropriate admissions, but spillovers are absent for high-complexity treatments. Two studies on secondary care relate to access, namely, hospital proximity and waiting times. Bertoli and Grembi investigate if hospital proximity in an emergency situation, proxied by road traffic accidents, affects health outcomes. They show that a one standard-deviation increase in the distance to the nearest hospital (5 km) raises the fatality rate by 13.84% at the sample average, which is equivalent to 0.92 additional deaths per 100 accidents. Proximity is more important when the level of road safety is low, when emergency services are less responsive, and when the nearest hospital has relatively low quality standards. Riganti et al. focus on waiting times for planned (elective) care, which are a major policy concern in publicly funded health systems across OECD countries. Economists have argued that, in the presence of excess demand, waiting times act as nonmonetary prices to bring demand for and supply of health care in equilibrium. They estimate demand and supply elasticities with respect to waiting times in Italy. They find that demand is inelastic to waiting times while supply is more elastic. The results imply that policies aimed at increasing supply can be effective in reducing waiting times. Atella et al. focus on primary care and investigate the role that drug adherence has on health outcomes, with a particular focus on asymptomatic chronic conditions. They show that patients and physicians characteristics play an important role in determining health status, and this is at least as important as drug adherence. Long-term care can be provided informally (e.g., by a spouse) or in formal settings (e.g., care homes and nursing homes). Informal care may substitute for formal long-term care, but the costs of informal caregiving are borne by the caregiver and may consist of worse health outcomes and, if the caregiver has not retired, worse labor market outcomes. de Zwart et al. estimate the impact of providing informal care to one's partner on the caregiver's health using a European survey. They find that in the short run, caregiving has a substantial effect on the health of caregivers and, for female caregivers, on their health care use. The health effects may, however, be short-lived and do not persist after 4 years. McMillen and Powers focus on formal long-term care. They identify factors that influence nursing home location choice in California, in particular in relation to agglomeration economies around hospitals. They find that nursing homes are more likely to locate in the same Census tract and are more likely to locate in tracts nearer to those containing a hospital. Policy makers and organizations representing people with disabilities have highlighted the importance of promoting the employment prospects of disabled individuals as a determinant to ensure their broader integration into the society. Policy reforms that attempt to incentivize disabled individuals to work typically involve reduced financial punishments for earning above a predetermined threshold (substantial gainful activity). Vall Castello exploits a Spanish reform that entirely eliminated any disincentives for disabled individuals to work and shows that the reform increased the probability of working by 6.5 percentage points for disabled men aged 55 or younger. Moscone, Siciliani, and Vittadini thank Andrew Jones, John Mullahy, and all the referees who helped us tremendously in selecting the papers for this special issue and whose very insightful comments contributed to improvements in the manuscripts.