Repubblica Palermo today gives the first part of a survey on the health of Sicily. Among the numbers reported there are no statistics on the number of doctors, nurses, the ratio between physicians and beds etc.. It follows immediately that the number of doctors, particularly primary, appears quite high, for example in relation to beds. But if there are so many doctors, why many of my friends when they needed to care for themselves or for relatives, went to other regions? That many doctors are not present symptoms of good quality? This might seem counterintuitive. The report easier that you may think it should be that the greater the number of doctors, the health service should be better. Then I tried to do a little analysis of the relationship between an indicator of quality of service and a measure of "number of doctors" in Italian regions. The data I've downloaded
here. What can INTED for "number of doctors? I considered a measure of the quantity "weighted", particularly in relation to the number of nurses. IQ call this indicator, the ratio of doctors (M) and nurses (I) in the region. This measure has some advantages: i) introducing an element of evaluation of the quality of staff (and not just the quantity), and the "choice of technique", ie the relationship between different types of work chosen from various regions. Moreover, it can also serve as an indicator of policies in the public sector. For example, in Sicily is well known that the number of managers in the PA is much higher than in regions of similar size. As an indicator of the quality of health services at regional level (IR), I calculated the ratio between the index of attraction (IA) and the index of flight (IF). The index of attraction is the ratio between the number of resignations of patients not living in the region and the total number of resignations. The rate of leakage is the ratio between the number of resignations of residents in the region carried out in a different region, and the total number of resignations of residents in the region. When IR = IA / IF is greater than one, it means that the region is better able to attract patients to reject that, and therefore this should be a good summary indicator of the overall quality of service. Conversely, when IR is less than one. A priori, one would expect that regions that use human capital intensive techniques
, that have a high level of IQ, also have a better service. At most we might expect a relationship to the concave or inverted U worse. The figure shows instead that it is clearly negative: in regions with higher IQ, IR is significantly lower. This, after deduction of the limits of this analysis (for example, does not control for physical capital available to employees for interregional specialization in the type of care provided for other determinants of the number of physicians (eg there are many doctors in Liguria, probably because it's large elderly population.)) indicates the likely presence of a problem. 1) The disproportionate recruitment of physicians does not increase the quality of service. Probably much of it depends on patronage grounds (from the Republic: the hospital in Catania there are 12 primary surgery). 2) The amount of resources absorbed by salaries of doctors crowds out spending on infrastructure (eg the number of beds, equipment, etc.), creating a situation not unlike that of the university, where the weight of salaries leaves little for infrastructure. 3) A large number of doctors compared to nurses in general may be a situation of sub-optimal combination of factors, such as whether there are diminishing returns in the number of doctors. A further test in which IQ correlates with the number of doctors per thousand population returns a negative relationship but not significant, which confirms in part what is written above, but certainly does not support the reverse hypothesis, plausible in principle, that many doctors per capita imply a better service. Finally, note one important aspect: the number of doctors and nurses refer to the public sector only, while the quality index considers the resignation in public and in those credited. This could introduce a bias in the analysis if the ratio between physicians and nurses in private was very different from that in public (I did not find data, but it seems strange). On the other hand, however, strengthens the findings, especially for regions that have a large private health sector such as Sicily. In other words, the quality of health services in Sicily is very low in the presence of many doctors to nurses in public and
a sector private well developed (something different happens in Lombardy, for example).
Repubblica Palermo today gives the first part of a survey on the health of Sicily. Among the numbers reported there are no statistics on the number of doctors, nurses, the ratio between physicians and beds etc.. It follows immediately that the number of doctors, particularly primary, appears quite high, for example in relation to beds. But if there are so many doctors, why many of my friends when they needed to care for themselves or for relatives, went to other regions? That many doctors are not present symptoms of good quality? This might seem counterintuitive. The report easier that you may think it should be that the greater the number of doctors, the health service should be better. Then I tried to do a little analysis of the relationship between an indicator of quality of service and a measure of "number of doctors" in Italian regions. The data I've downloaded here. What can INTED for "number of doctors? I considered a measure of the quantity "weighted", particularly in relation to the number of nurses. IQ call this indicator, the ratio of doctors (M) and nurses (I) in the region. This measure has some advantages: i) introducing an element of evaluation of the quality of staff (and not just the quantity), and the "choice of technique", ie the relationship between different types of work chosen from various regions. Moreover, it can also serve as an indicator of policies in the public sector. For example, in Sicily is well known that the number of managers in the PA is much higher than in regions of similar size. As an indicator of the quality of health services at regional level (IR), I calculated the ratio between the index of attraction (IA) and the index of flight (IF). The index of attraction is the ratio between the number of resignations of patients not living in the region and the total number of resignations. The rate of leakage is the ratio between the number of resignations of residents in the region carried out in a different region, and the total number of resignations of residents in the region. When IR = IA / IF is greater than one, it means that the region is better able to attract patients to reject that, and therefore this should be a good summary indicator of the overall quality of service. Conversely, when IR is less than one. A priori, one would expect that regions that use human capital intensive techniques , that have a high level of IQ, also have a better service. At most we might expect a relationship to the concave or inverted U worse. The figure shows instead that it is clearly negative: in regions with higher IQ, IR is significantly lower. This, after deduction of the limits of this analysis (for example, does not control for physical capital available to employees for interregional specialization in the type of care provided for other determinants of the number of physicians (eg there are many doctors in Liguria, probably because it's large elderly population.)) indicates the likely presence of a problem. 1) The disproportionate recruitment of physicians does not increase the quality of service. Probably much of it depends on patronage grounds (from the Republic: the hospital in Catania there are 12 primary surgery). 2) The amount of resources absorbed by salaries of doctors crowds out spending on infrastructure (eg the number of beds, equipment, etc.), creating a situation not unlike that of the university, where the weight of salaries leaves little for infrastructure. 3) A large number of doctors compared to nurses in general may be a situation of sub-optimal combination of factors, such as whether there are diminishing returns in the number of doctors. A further test in which IQ correlates with the number of doctors per thousand population returns a negative relationship but not significant, which confirms in part what is written above, but certainly does not support the reverse hypothesis, plausible in principle, that many doctors per capita imply a better service. Finally, note one important aspect: the number of doctors and nurses refer to the public sector only, while the quality index considers the resignation in public and in those credited. This could introduce a bias in the analysis if the ratio between physicians and nurses in private was very different from that in public (I did not find data, but it seems strange). On the other hand, however, strengthens the findings, especially for regions that have a large private health sector such as Sicily. In other words, the quality of health services in Sicily is very low in the presence of many doctors to nurses in public and a sector private well developed (something different happens in Lombardy, for example). 
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