Research

Last update: October 2025

Published Papers

Cash transfers and health outcomes: evidence from Italian municipalities
(joint with C. Guccio, G. Pignataro, D. Romeo, Health Policy, 2025)

BackgroundCash transfer programs are widely used to support household income and improve socioeconomic well-being. We examine the health impact of a nationwide transfer introduced in Italy in 2015, targeted at middle-income groups and providing up to €960 annually per beneficiary.ObjectiveTo assess the effect of the program on municipal all-cause mortality.MethodsLeveraging panel data for all municipalities from 2010 to 2019, we exploit variation in treatment intensity induced by eligibility rules. Intensity is measured via per capita disbursements and share of beneficiaries. We estimate fixed-effects regressions with socio-demographic and economic covariates, regional time trends, and controls for spatial dependence.ResultsIncreased transfer intensity is significantly associated with lower mortality: an additional €1 per capita corresponds to 0.004 fewer deaths per 1,000 residents, while a one-percentage-point increase in the beneficiary share corresponds to a 0.03 decrease in the same outcome. Heterogeneity analyses suggest stronger effects in municipalities with higher education levels and better healthcare access, indicating that these factors enhance the translation of income support into health gains.ConclusionsAlthough not designed with health objectives, broad-based income support programs can yield measurable improvements in population health, particularly when complemented by education and healthcare investments.

Threshold of shadows: Unveiling organised crime in Italian municipal public procurement
(joint with G. d'Agostino, European Journal of Political Economy, 2025)

This paper investigates the complicity of local public buyers in enabling the diversion of resources to organised crime through the manipulation of contract values in public works and services. Exploiting a discontinuity in anti-mafia screening procedures, we analyse a comprehensive dataset of public procurement contracts issued by Italian municipalities spanning from 2007 to 2019. Bunching estimators reveal a distinct pattern of contract value manipulation occurring just below the anti-mafia screening threshold of €150,000, with a heightened concentration observed in public works projects and provinces characterised by a higher prevalence of mafia influence. Our empirical analysis further shows that bunching is significantly more pronounced in municipalities that are later dissolved for mafia infiltration. Contracts below the threshold are also more likely to involve limited competition and to be awarded to firms with financial traits consistent with the hypothesis of mafia infiltration. By following the full procurement chain – from the design of the contract, to how competition is shaped, to who ultimately wins – we provide new evidence of collusion risks in local procurement, and highlight the importance of enhanced safeguards to counter corruption and organised crime within public procurement processes.

Measuring hospital care resilience: a systematic literature review
(joint with M. Cavalieri, C. Guccio, D. Lisi, M. Martorana, G. Pignataro, D. Romeo, The European Journal of Health Economics, 2025)

The recent Covid-19 pandemic has shown how even high-performing healthcare systems are often unprepared to cope with sudden and unforeseen surges in demand for healthcare services, drawing further attention on crucial factors ensuring their resilience in the face of extreme disruptive events. Despite extensive efforts to define health system resilience, a lack of consensus persists, making it difficult to operationalize the existing conceptual frameworks and to guide policy makers in developing adequate response strategies. Grounded on this, the present paper aims to systematically review how hospital resilience has been measured in high-income countries. Particularly, we intend to map out the different indicators and metrics used to quantitatively assess the hospitals’ capacity to proactively face sudden health shocks, which can put clinical activity under pressure and at risk of disruption. Adhering to PRISMA guidelines, a systematic literature search was conducted until March 2023, by combining three databases. The review identified 1,261 studies of which 45 studies met the eligibility criteria. We found a wide range of methodological approaches that shared a narrow focus on single aspects of hospital resilience, without being able to measure it comprehensively and systematically and without accounting for its dynamic and feedback loop nature. Specifically, most of the studies looked at how to measure hospitals’ capacity to absorb the shock and adapt to it, while almost neglecting their transformative capacity as well as the legacy or enduring impact of shocks.

Too big to be efficient? The role of size in public procurement performance
(joint with M. Caserta, L. Ferrante, P. Ferrara, Economic Analysis and Policy, 2025)

Developed countries allocate a significant portion of their public spending to goods and services. Especially when it comes to building and restoring the country's infrastructure, the attention of politicians and analysts is very strong, given the impact that these works can have on the national economy, both in the short and long term. The aim of this paper is to investigate how some specific factors of the public procurement process, namely the dimensions of public contracts, contracting authorities, and winning firms, impact public procurement efficiency. We employ a panel dataset of approximately 90,000 public works contracts awarded in Italy from 2007 to 2019, focusing on cost overruns and time delays as measures of inefficiency. The issue is especially topical as the Italian legislation on public procurement was recently reformed in the direction to foster the contracting out of larger contracts albeit making easier to subcontract their implementation. Our results confirm that dimensions matter. Specifically, larger contracts and subcontracting practices tend to correlate with higher inefficiency, while both cost overruns and delays decrease when contracts are assigned by bigger (more experienced) contracting authorities or to larger firms. Furthermore, we delve into the interplay among these dimensions and institutional quality, highlighting that the latter is a critical factor mediating the impact of some procurement-level characteristics on cost inefficiencies. Overall, our findings strongly advocate for the qualification of contracting authorities, underscore the importance of tender dimensions in determining inefficiencies, and emphasize the need to account for institutional quality when designing procurement policies.

Anti-mafia policies and public goods in Italy
(joint with G. d'Agostino, Public Choice, 2024)

This paper aims to evaluate the impact of a policy that targets criminal infiltration in local governments on the provision of local public goods in Italian municipalities. Building on the theoretical framework proposed by Dal Bò (American Political Science Review 100:41–53, 2006), we use a sufficient statistic approach to describe the dynamic behaviour of local public goods when stricter law enforcement weakens criminal pressure groups. Utilizing data on the local public finances of Italian municipalities spanning from 2004 to 2015, our findings reveal that, after the dismissal of infiltrated governments, the targeted municipalities devote a larger share of resources to public goods, with an estimated increase of approximately 3.9 percentage points. Notably, this effect seems to be driven by an increase in investment of approximately 3 percentage points. Overall, our results suggest that policies targeting the problem of criminal infiltration in local governments can improve socioeconomic conditions and the well-being of local communities, by increasing investments in economically and socially relevant public goods.

Mafia and bricks: unfair competition in local markets and policy interventions
(joint with L. Ferrante and F. Reito, Small Business Economics, 2021)

One of the characteristics of modern mafia-type organizations is their ability to infiltrate or influence the legal economy. In this paper, we provide evidence of the strong relationship between mafia and market concentration in Sicily. We use data on Sicilian municipalities and show that the presence of mafia-type organizations is associated with a high degree of market concentration in the construction industry. We also analyze the impact of two anti-mafia policies, the dismissal of city councils for mafia infiltration, and the seizure and reassignment of firms owned by the mafia, and evaluate their effects on the degree of competition in local entrepreneurship. We show that the seizure policy, which directly affects the financial interests of criminal organizations, can reduce their dominant economic positions and lead to higher market competition.

Working Papers

Better Politicians, Fewer Deaths? Municipal Resilience in Overcoming the Pandemic Crisis in Italy
(joint with C. Guccio, G. Pignataro, F. Vidoli, HEDG Working Papers, University of York, 2025)

The quality of institutions is widely recognized as a fundamental determinant of public sector performance across various levels of governance. In this paper, we investigate the role of institutional quality in shaping the resilience of Italian municipalities during the COVID-19 pandemic. To this end, we introduce a novel non-parametric approach to construct a resilience index based on historical mortality data, which serves as a counterfactual benchmark, estimated at the local level, for assessing pandemic-related outcomes. This methodology enables a more nuanced and context-specific measurement of resilience. We apply the index to municipal-level mortality data in Italy from 2004 to 2023 to evaluate the heterogeneous ability of municipalities to withstand and recover from the pandemic crisis. By linking this resilience index with detailed municipal-level indicators of institutional quality, we find that higher institutional quality is strongly associated with greater resilience in managing the crisis. Moreover, when disentangling the specific components of institutional quality, we identify the quality of local politicians as the most significant factor driving differential performance. Our results are robust to a variety of sensitivity checks.

Selected Work in Progress

Criminal infiltrations in the legal economy and public procurement efficiency in Italy
(joint with L. Ferrante)

The aim of this paper is to assess how mafia infiltration in the legal economy influences the performance of public work contracts in Italy. We use a dataset on about 70,000 public work contracts awarded in Italy from 2007 to 2021, and we assess two relevant dimensions of inefficiency in the execution of public works: cost overruns and time delays. We show that mafia infiltration in the public works sector, proxied by the presence of construction firms that will later be confiscated, determines higher cost overruns of about 4 percentage points. Moreover, we show that cost overruns are even higher (18 percentage points) when also local governments are infiltrated, suggesting that mafia firms operating in the local area leverage on political connections to secure contracts and renegotiate prices during the execution. We do not find significant effects with respect to delays in the execution of works.

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