Quality and health care performance in the Italian regions

This paper estimates the total factor productivity of the Italian health care sector using a modified bootstrapped Malmquist Index including the quality of the production process provided to the population. Decomposing the productivity process in three different components (efficiency change, technological change and quality change) we can detemine if the increasing/decreasing health care productivity of the 20 Italian regions is strictly related to any of the changes during 1999-2008. The results highlights also significant difference in the terms of North-South divide.