89207 - Health Economics

Academic Year 2021/2022

  • Docente: Silvia Gatti
  • Credits: 6
  • SSD: SECS-P/01
  • Language: Italian

Learning outcomes

At the end of the course the student will be familiar with the most important activities and objectives of the healthcare sector, with particular reference to the institutional aspects and strategic plans. In particular, the student is able to: identify the factors influencing the supply/demand dynamics of healthcare services; analyse the production of healthcare goods and services; economically evaluate the healthcare activities using appropriate evaluation methods.

Course contents

Introduction: Health economics: definitions and areas of analysis.

First part: The relationships between the health sector and the rest of the economy. Health concepts. Determinants of health. Economic development and health. Relationship between Education, Income, Early Childhood Development and Health. An analysis according to inequalities. Elements of National Accounting. National accounting and health activities. Relations between GDP, GDP per capita and Health expenditure and health expenditure per capita. Exercises on the databases of international and European organizations responsible for the management of health policies, to update the issues addressed in the first part of the teaching and in preparation for the drafting of the first paper. Presentation of questions and drafting requirements for the first [for attending] group paper on the topics of the first part of the course to be presented in class.

Second Part: The Functioning of Market, Health Demand and Production and Supply of Health Services. Characteristics of the Perfect Competition Market. Consumer preferences and the demand function of a good. Supply function of a good and market equilibrium. The need for health. Private need and public need. Externalities. Health as a merit need. Demand for health services. The Production of Health Services. Efficiency, Effectiveness and Performance in Healthcare. Scientific progress, technological development and innovation in health. Presentation of the first group papers in class. The concepts of Equity in Healthcare and in the Italian National Health Service. The Essential Levels of Care. Their monitoring. The sustainability of the National Health Service. Who controls the SSN and the SSR. Function of Production, Productivity, Costs in Health Services. Optimal size of the hospital. Productivity and Cost Controls: Standard Costs, Diagnosis Related Groups. The demand for hospitalization. The catchment areas. Health planning. From National Health Plans to State-Regions Agreements. Health Federalism and NHS Financing. Exercises on the databases of the Ministry of Health in preparation for the second individual paper [attending] on the topics of the second part of the course to be presented for the oral exam. The economic evaluation of health activities.

The contents indicated are for both attending and non-attending students.



Brenna A. (2003), Manuale di Economia Sanitaria. Per una gestione razionale delle risorse, Milan, published by CIS.

Supplementary readings will be recommended during the teaching:

Dirindin N., Vineis P. (2004), Elementi di Economia Sanitaria, Bologna, Il Mulino, cap. 2, paragrafi dall'1 al 4; cap. 4, paragrafo 4.6.

For further details on the topics of microeconomic theory analysed during the teaching:

  • Mankiw G.N., Taylor M.P. (2015), Principi di economia, Bologna, Zanichelli, chapters 3, 4, 5 e 6.


  • Goolsbee A., Levitt S., Syverson C. (2014), Microeconomia, Bologna, Zanichelli (parts reported during the teaching and indicated in the course materials).

Heckman J.J. (2012), The Developmental Origin of Health, Health Economics, 21: 24-29.

Banerjee A.V., Duflo E., Glennerster R., Kothari D. (2010), Improving immunisation coverage in rural India: clustered randomised controlled evaluation of immunisation campaigns with and without incentives, British Medical Journal, 2010;340:doi:10.1136/bmj.c2220.

Doran T., Fullwood C., Gravelle H., Reeves D., Kontopantelis E., Hiroeh U., and Roland M. (2006), Pay-for-Performance Programs in Family Practices in the United Kingdom, New England Journal of Medicine, 2006;355:375-84.

Gillam S.J., Siriwardena A.N., Steel N.(2012), Pay-for-Performance in the United Kingdom: Impact of the Quality and Outcomes Framework—A Systematic Review, Annals of Family Medicine, September/October 2012 10:461-468.

Ministero della Salute (2019), Programmazione sanitaria, http://www.salute.gov.it/portale/temi/p2_4.jsp?lingua=italiano&tema=Piani, finanziamenti e monitoraggio del SSN&area=programmazioneSanitariaLea , Last access July 15, 2021.

Ministero della Salute (2021), Servizio Sanitario Nazionale: i LEA, http://www.salute.gov.it/portale/lea/homeLea.jsp, Last access July 15, 2021.

Ministero della Salute (2020), Ricoveri ospedalieri (SDO), Il sistema DRG,http://www.salute.gov.it/portale/temi/p2_6.jsp?lingua=italiano&id=1349&area=ricoveriOspedalieri&menu=vuoto, Last access July 15, 2021.

Further readings:

On the Utility:

Dolan P., Kahneman D. (2008), Interpretations of Utility and Their Implications for Valuation of Health, The Economic Journal, 118, (January), 215-234.

On Equity and Discrimination:

Costa G. (2014), Promuovere equita' di salute e di sanita' in Italia, in L'equita' nella salute in Italia (eds. Costa G. et alii), Milano, Franco Angeli Editore, 13-42.

Ashenfelter O., Oaxaca R. (1987), The Economics of Discrimination: Economists Enter the Courtroom, American Economic Review, vol. 77, n.2, May, pp. 321-25.

On Taxation:

Gruber J. (2018), Scienza delle Finanze, Milan, published by Egea.


Teaching resources on Virtuale [https://virtuale.unibo.it/course/view.php?id=20630]

Teaching methods

Lectures; group work; exercises;

Commentary during the lessons (both in presence and online) on two of the supplementary articles.

(During the COVID pandemic and the on line lessons the laboratory exercises are replaced by exercises assigned after the lessons and reviewed together during the following lessons).


The students are required to prepare two papers : the first (by group) prepared during the teaching and presented in the classroom, the second (individual) prepared for the examination and presented there.

The evaluation of the paper will be made on three elements:
1. Correctness and completeness of the theoretical notions on the topic of the paper (up to 9 points out of 30)
2. Detection capabilities of the explanatory variables, identification of relevant data, the ability to interpret the data and make an organized comment on them (up to 15 points out of 30)
3. Compliance with the requirements for the preparation of the paper sent to students by email (up to 6 points out of 30)

Assessment methods

The assesment methods are aimed at verifying the achievement of the knowledge and skills object of the course (know, identify, analyze, evaluate, ...):

Method: Oral exam, in addition to the evaluation of the group paper written during the course, and the individual paper that must be turned in (and evaluated) before the oral exam.

Weights for the final evaluation (vote out of thirty):
First paper: 30%
Second paper: 35%

Oral exam (which will be carried out throughout all the program excluding the first part "Macroeconomic" of the first paper and excluding the theme of the second paper): 35%

N.B. Students who do not attend the course must prepare a paper on questions of a broad topic agreed with the professor, according to the drafting requirements of the paper. The paper must be turned in (and evaluated) before the oral exam. Students take the oral examination on the whole program. In this case, for the final evaluation the paper and the oral examination will have equal weight (50% and 50%).


There are no recorded intermediate exams.

Teaching tools

Lectures with PC and video projector (after COVID also with blackboard)

Computer lab exercises (after COVID) with PC, video projector and blackboard. (During the COVID pandemic and the on line lessons the laboratory exercises are replaced by exercises assigned after the lessons and reviewed together during the following lessons).



Office hours

See the website of Silvia Gatti


Good health and well-being

This teaching activity contributes to the achievement of the Sustainable Development Goals of the UN 2030 Agenda.