Essays in Health Economics: Applied and Theoretical Approaches

the present report illustrates the research path developed during the PhD program in Economics at the University of Genova and discuss its results. The report consists of three independent chapters which reflect the chronological order of the activities carried out during the program. In the first 2 chapters, two articles are discussed. They belong to the research field inaugurated by Townsend (1987), that is, the analysis of deprivation in urban contexts and the relation between socio economic conditions and health status. The first article consists in a detailed analysis of the distribution of deprivation in the metropolitan city of Genoa and of its relationship with the health status of the resident population, represented by a generic measure of health such as premature mortality. Information on 14 variables used to assess deprivation was available at the level of the Unità Urbanistiche. These are small administrative units with territorial homogeneity and historical and cultural traditions which appear to be suitable for statistical analyses. An exploratory factorial analysis identified two groups of variables which, according to definitions in the literature, identify the two dimensions of deprivation, material deprivation and social deprivation. For each dimension, two indices were calculated on the basis of two non-compensatory methodologies, the Mazziotta Pareto Index and the Pena Distance Index. Health status was measured through a measure of premature mortality, measured through the calculation of age-standardized SMR. The calculation of the attributable risk was used to evaluate the proportion of the excess mortality observed in various areas which can be attributable to deprivation, and a geographical analysis is presented. The results of the work, in line with the available evidence, confirm the association between material deprivation and premature mortality, but fail to show a relationship with social deprivation. The second article presents the results of an analysis of deprivation in Argentine urban areas, with the aim of assessing the presence of a relationship with the average health status of the residents Based on data extracted from the 2017 Survey on Permanent Families in Argentina (EPH), a continuous survey carried out on 32 urban areas in Argentina, five variables were identified, four relating to material and the fifth to social deprivation. The Mazziotta-Pareto Adjusted Index was calculated to provide a synthetic and quantitative measure of the level of deprivation. An analysis of hierarchical clusters was carried out to group different urban areas into deprivation classes and analyse the state of health. The primary measure of the health status used in this study was Life Expectancy at birth. The results, in line with the literature, allow to conclude that the proposed mixed deprivation index accounts for a significant proportion of the variability in Life expectancy at birth across urban areas. In the third chapter , a study is presented that was developed in in the research field of contract theory. In particular, it refers to contracts in the presence of information asymmetry and the consequent moral hazards and it is aimed at providing policy makers with a tool for an informed use of resources while identifying the sources of inefficiency and waste. The study is focussed on the problem of defining contracts for the provision of transport services for people with disabilities in a Principal-Agent context. The main issues derive from the hidden actions of the agent and the uncertainty which is due to the type and level of disability of the user which give rise to problems of incomplete information. The work consists of two parts. In the first, the conceptual framework, the theoretical tools and the main assumptions are presented, including: the description of a principal-agent relation under asymmetric information; the optimization problem of the principal; the description of the causal variables, which are the effort applied by the agent in the supply of the service and the disability condition of the user, which, in general terms, is referred to as "complexity"; the statistical tool used to model the probability related to the uncertainty which characterizes the service analysed, which is the logistic function; the relation between independent variables and outcome variable; and the agent’s risk aversion. The second part of the study includes the description of two empirical models which, through various simulations, analyse how causal variables affect the probability of the positive result that is the regular performance of the transport service, the expected principal expenditure and the expected agent utility. The results suggest that, as expected, the more complex the disability condition of the user is, the greater expected expenditure of resources is, but the analysis of the dynamics of the contract, which has actually highlighted the opportunity for unfair behaviours of the agent, suggests that moral hazard is stronger in situations where the user is less complex. As the user’s level of disability increases, the agent is less inclined to implement opportunistic behaviours as the uncertainty of the final result increases exogenously.