“Job Satisfaction Among Healthcare Workers in the Aftermath of the COVID-19 Pandemic ” (with P. Bertoli, V.Grembi and V. Rattini) - PDF - PLOS ONE: Forthcoming
Using a unique survey of more than 7,000 respondents conducted immediately after the first wave of the COVID-19 pandemic in Italy, we investigate potential drivers of the job satisfaction of healthcare workers. Relying on a representative sample of Italian physicians and nurses, we show that, besides personal characteristics (e.g., age, gender, health status), contextual factors (i.e., working conditions) play the leading role in explaining variation in the level of satisfaction (58%). In particular, working in a high-quality facility increases worker satisfaction and willingness to remain in the profession, and in the current medical specialization, while working in a province with a perceived shortage of medical personnel brings the opposite result. Direct experience with COVID-19 (e.g., having tested positive) is not significantly correlated with the level of job satisfaction, which is instead significantly reduced by changes in the working conditions caused by the health emergency.
Keywords: Healthcare Workers, Job Satisfaction, COVID-19 Pandemic
“Neighborhoods, Networks, and Delivery Methods” (with P. Bertoli and V.Grembi) - Journal of Health Economics, 80(102513), 2021
We investigate potential mechanisms of information transmission among patients when explaining territorial variations in the use of cesarean sections. Defining networks as mothers living in the same Italian municipality (average size about 10,000 residents), we show that an increase by a standard deviation of the incidence of cesarean sections in the 12 months before the delivery date in the municipality of residence of the future mother increases the probability of receiving the treatment by 3%. This result captures mainly networks effects for Italian mothers, while it does capture both networks and neighborhood effects for immigrant mothers. Both groups adjust for the transmission of information on the incidence of complications due to cesarean sections. Selection of mothers across hospitals does not uniquely explain our results, which are robust to alternative samples selection.
Keywords: Cesarean Sections, Networks, Neighborhood effects
"Fees Equalization and Appropriate Health Care" (with P. Bertoli and V.Grembi) - Economics and Human Biology, 41, 2021
Fees equalization in health care brings under a unique tariff several medical treatments, coded under different Diagnosis Related Groups (DRGs). The aim is to improve healthcare quality and effciency by discouraging unnecessary, but better-paid, treatments. We evaluate its effectiveness on childbirth procedures to reduce c-section overuse by equalizing the DRGs for vaginal and cesarean deliveries. Using Italian data and a difference-in-differences approach, we show that setting an equal reimbursement decreased c-sections by 2.5%. This improved the appropriateness of medical decisions with more low-risk mothers delivering naturally and no significant changes in the incidence of complications for vaginal deliveries. Our analysis supports the effectiveness of fees equalization in averting c-sections, but highlights the marginal role of fnancial incentives in driving c-section overuse which went back to normal in the short run. We found a stronger reduction in low-quality, and more capacity constrained hospitals. Moreover, the effect is driven by districts where the availability of Ob-Gyn specialists is higher and where women are predominant in the gender composition of the specialty-group.
Keywords: Fees Equalization, Cesarean Sections, Difference in Differences