How efficient is the Italian health system? Evidence on the role of political-institutional dynamics

In a context of dwindling resources, an ageing population and increased costs for accessing technologies, improving healthcare systems efficiency has become a matter of great urgency. Public administrators play a crucial role in bringing about the efficient management of resources. Thus, it has become important to assess the efficiency of national health systems and to identify and eliminate inefficiencies in resource management. By exploiting a stochastic frontier analysis, the paper aims at assessing the determinants of health system efficiency in 20 Italian regions, between 2001 and 2018. Political and institutional factors affecting health sector perfor- mance have been identified. Italy has been chosen as a case study due to its decentralized structure and its assignment of decision-making roles to regional politicians and administrators. The main finding shows that institutional quality cannot be considered a marginal determinant, since it exerts a direct effect on healthcare systems’ activities and an indirect influence on people’s life quality.