Quality behind quantity: institutions and hospital management

Purpose This paper aims to investigate the contextual determinants of Italian hospital efficiency by examining the interplay between managerial levels and their impact on health service provision. Design/methodology/approach Utilizing data from 2019 from the Ministry of Health, ISTAT portal and the Italian Institutional Quality index dataset, we employ the two-stage network data envelopment analysis (NDEA) to measure hospital efficiency on the basis of different quantitative input–output proxies. By means of a second-level analysis (regression), estimates reveal a positive correlation between the qualitative measures of hospital management at regional and local level and hospital efficiency, where the quality of healthcare care management positively influences efficiency. Findings Results highlight the importance of case-mix and entropy indices in determining efficiency, shedding light on the relationship between quantitative efficiency and specific hospital management quality. Furthermore, the study explores the significance of high-quality local management, as the local Institutional Quality Index positively correlates with hospital efficiency. The result is discussed in the light of the health–growth nexus, emphasizing the role of the institutional quality in fostering growth, suggesting a comprehensive “institutions–health–growth” nexus, where the quality of the institutional system exacerbates the health-led economic growth and social prosperity. Originality/value The originality of the work lies mainly in its contribution to the literature on the efficiency of healthcare organizations, considering the impact of managerial quality (both local and regional). Furthermore, the paper concludes suggesting different extensions of the current work, broadening the applicability of the findings.