title: The effect of healthcare delivery privatisation on avoidable mortality: longitudinal cross-regional results from Italy, 1993-2003.
abstract: BACKGROUND
  During the 1990s, Italy privatised a significant portion of its healthcare delivery. The authors compared the effectiveness of private and public sector healthcare delivery in reducing avoidable mortality (deaths that should not occur in the presence of effective medical care).
  
  
  METHODS
  The authors calculated the average rate of change in age-standardised avoidable mortality rates in 19 of Italy's regions from 1993 to 2003. Multivariate regression models were used to analyse the relationship between rates of change in avoidable mortality and levels of spending on public versus private healthcare delivery, controlling for potential demographic and economic confounders.
  
  
  RESULTS
  Greater spending on public delivery of health services corresponded to faster reductions in avoidable mortality rates. Each €100 additional public spending per capita on NHS delivery was independently associated with a 1.47% reduction in the rate of avoidable mortality (p=0.003). In contrast, spending on private sector services had no statistically significant effect on avoidable mortality rates (p=0.557). A higher percentage of spending on private sector delivery was associated with higher rates of avoidable mortality (p=0.002). The authors found that neither public nor private sector delivery spending was significantly associated with non-avoidable mortality rates, plausibly because non-avoidable mortality is insensitive to healthcare services.
  
  
  CONCLUSIONS
  Public spending was significantly associated with reductions in avoidable mortality rates over time, while greater private sector spending was not at the regional level in Italy.
authors.affiliation: Dipartimento di Fisiopatologia, Medicina Sperimentale e Sanita Pubblica, Universita degli Studidi Siena, Siena, Italy. quercioli2@unisi.it
authors.forename: Cecilia
authors.initials: C
authors.lastname: Quercioli
authors.forename: Gabriele
authors.initials: G
authors.lastname: Messina
authors.forename: Sanjay
authors.initials: S
authors.lastname: Basu
authors.forename: Martin
authors.initials: M
authors.lastname: McKee
authors.forename: Nicola
authors.initials: N
authors.lastname: Nante
authors.forename: David
authors.initials: D
authors.lastname: Stuckler
mesh_terms: D017677:Age Distribution; D002423:Cause of Death / Q000639:trends; D003695:Delivery of Health Care / Q000191:economics* / Q000639:trends; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D017149:Private Sector; D011332:Privatization; D017150:Public Sector; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012959:Socioeconomic Factors