Exploring health outcomes by stochastic multicriteria acceptability analysis: An application to Italian regions

This paper introduces the Stochastic Multi-Objective Acceptability Analysis (SMAA) in order to investigate the evolution of mortality rates in the Italian regions over the period 1990-2013. We propose to explore the overall outcome of health care by a Composite Index (CI) of mortality based on the combination of standardized mortality rates for seventeen different diseases. From a methodological standpoint, we propose to overcome the arbitrary of the weighting process, by using the SMAA, which is a methodology that allows to rank regions considering the whole set of possible vectors of weights. Moreover, we explore the spatial segregation in health using the multidimensional generalization of the Gini index, and introducing the multidimensional generalization of ANOGI. The unprecedented use of SMAA in health sector allows to explore regional multidimensional paths beyond the order of importance given to the single dimensions. Our analysis shows that in the 24 years considered there has been no convergence path in terms of health care outcome in Italy, neither between nor within regions.

[1]  Graham Pyatt,et al.  On the interpretation and disaggregation of GINI coefficients , 1976 .

[2]  S. Greco,et al.  Robust Ordinal Regression and Stochastic Multiobjective Acceptability Analysis in multiple criteria hierarchy process for the Choquet integral preference model , 2016 .

[3]  Risto Lahdelma,et al.  SMAA-2: Stochastic Multicriteria Acceptability Analysis for Group Decision Making , 2001, Oper. Res..

[4]  Giuliano Resce,et al.  The Cost of Well-Being , 2015, SSRN Electronic Journal.

[5]  José Rui Figueira,et al.  Dealing with a multiple criteria environmental problem with interaction effects between criteria through an extension of the Electre III method , 2015, Eur. J. Oper. Res..

[6]  F. Moirano,et al.  Performance measurement in response to the Tallinn Charter: experiences from the decentralized Italian framework. , 2012, Health policy.

[7]  Amartya Sen,et al.  Mortality as an indicator of economic success and failure : inaugural lecture 1995 , 1995 .

[8]  Silvia Angilella,et al.  The financing of innovative SMEs: A multicriteria credit rating model , 2013, Eur. J. Oper. Res..

[9]  Z. Or.  Exploring the effects of health care on mortality across OECD countries , 2000 .

[10]  Branko Milanovic,et al.  Decomposing World Income Distribution: Does the World Have a Middle Class? , 2001 .

[11]  Laurens Cherchye,et al.  An Introduction to ‘Benefit of the Doubt’ Composite Indicators , 2007 .

[12]  R. Lagravinese,et al.  The growth and variability of regional taxes: an application to Italy , 2018 .

[13]  G. Resce,et al.  Public Sector Contribution To Competitiveness , 2015 .

[14]  S. Greco,et al.  On the Methodological Framework of Composite Indices: A Review of the Issues of Weighting, Aggregation, and Robustness , 2019 .

[15]  P. Liberati.  The World Distribution of Income and its Inequality, 1970–2009 , 2015 .

[16]  Tommaso Luzzati,et al.  An exercise in composite indicators construction: Assessing the sustainability of Italian regions , 2011 .

[17]  Pietro Tommasino,et al.  Public Sector Efficiency and Political Culture , 2011 .

[18]  F. Tediosi,et al.  European Regional Differences in All-Cause Mortality and Length of Stay for Patients with Hip Fracture. , 2015, Health economics.

[19]  A. Torbica,et al.  Funding health technologies in decentralized systems: A comparison between Italy and Spain. , 2009, Health policy.

[20]  Alberto Zanardi,et al.  Fiscal decentralization in the Italian NHS: what happens to interregional redistribution? , 2011, Health policy.

[21]  Shlomo Yitzhaki,et al.  Economic distance and overlapping of distributions , 1994 .

[22]  Edna Schechtman,et al.  The Gini Methodology: A Primer on a Statistical Methodology , 2012 .

[23]  Robert I. Lerman,et al.  INCOME STRATIFICATION AND INCOME INEQUALITY , 1991 .

[24]  Jan Goebel,et al.  Using Analysis of Gini (ANOGI) for Detecting Whether Two Subsamples Represent the Same Universe , 2006 .

[25]  Risto Lahdelma,et al.  SMAA - Stochastic multiobjective acceptability analysis , 1998, Eur. J. Oper. Res..

[26]  John A. Weymark,et al.  The Normative Approach to the Measurement of Multidimensional Inequality , 2004 .

[27]  Risto Lahdelma,et al.  Decision support for centralizing cargo at a Moroccan airport hub using stochastic multicriteria acceptability analysis , 2010, Eur. J. Oper. Res..

[28]  Tommi Tervonen,et al.  Implementing stochastic multicriteria acceptability analysis , 2007, Eur. J. Oper. Res..

[29]  Stefano Tarantola,et al.  Handbook on Constructing Composite Indicators: Methodology and User Guide , 2005 .

[30]  Risto Lahdelma,et al.  Locating a waste treatment facility by using stochastic multicriteria acceptability analysis with ordinal criteria , 2002, Eur. J. Oper. Res..

[31]  Alessio Ishizaka,et al.  Multi-criteria Decision Analysis: Methods and Software , 2013 .

[32]  Francesco Porcelli,et al.  Electoral accountability and local government efficiency: quasi-experimental evidence from the Italian health care sector reforms , 2014 .

[33]  Jos Van Orshoven,et al.  Evaluation of modelling techniques for forest site productivity prediction in contrasting ecoregions using stochastic multicriteria acceptability analysis (SMAA) , 2011, Environ. Model. Softw..

[34]  Constantin Zopounidis,et al.  Assessing financial distress where bankruptcy is not an option: An alternative approach for local municipalities , 2012, Eur. J. Oper. Res..

[35]  S. Yitzhaki,et al.  The 'Melting Pot': A Success Story? , 2007 .

[36]  Iñaki Permanyer,et al.  Assessing the Robustness of Composite Indices Rankings , 2011 .

[37]  M. Doumpos,et al.  Bank overall financial strength: Islamic versus conventional banks , 2017 .

[38]  Robert Costanza,et al.  Modelling and measuring sustainable wellbeing in connection with the UN Sustainable Development Goals , 2016 .

[39]  S. Greco,et al.  Stochastic multi-attribute acceptability analysis (SMAA): an application to the ranking of Italian regions , 2018 .

[40]  M. Cavalieri,et al.  Does fiscal decentralization improve health outcomes? Evidence from infant mortality in Italy. , 2016, Social science & medicine.

[41]  G. Turati.  The Italian Servizio Sanitario Nazionale: A Renewing Tale of Lost Promises , 2013 .

[42]  J. Nicholl,et al.  Why do we continue to use standardized mortality ratios for small area comparisons? , 2001, Journal of public health medicine.

[43]  Angus Deaton,et al.  Mortality, Inequality and Race in American Cities and States , 2001, Social science & medicine.