We study the effect of institutional quality on the appropriateness of healthcare provision in Italian hospitals. We focus on cesarean section rates for first-time mothers, which is a common indicator of appropriateness in healthcare and is vulnerable to providers’ opportunistic behaviors. To identify the causal effect of institutional quality we rely on an IV strategy based on historical instruments, exploiting the idea that current differences in institutional quality across regions have been shaped by different cultural and political histories. We find that a standard deviation increase in our indicator of institutional quality leads to a decrease of about 10 percentage points in cesarean section rates. Our results are robust to different measures of institutional quality and samples.

我们研究了机构质量对意大利医院医疗保健适当性的影响。我们关注初次剖腹产的比率，这是医疗保健是否适当的常见指标，并且容易受到提供者的机会主义行为的影响。为了确定制度质量的因果关系，我们依靠基于历史工具的IV策略，利用这样的思想，即当前地区间制度质量的差异是由不同的文化和政治历史所塑造的。我们发现，我们机构质量指标的标准差增加导致剖宫产率降低约10个百分点。我们的结果对于机构质量和样本的不同度量是可靠的。