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Marcello MORCIANO

Professore Associato
Dipartimento di Economia "Marco Biagi"

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Pubblicazioni

2024 - Stima del fabbisogno e della spesa long term-care in Italia: valutazioni ex-ante di una proposta di riforma [Working paper]
Ranci, Costanzo; Audino, Francesca; Mazzaferro, Carlo; Morciano, Marcello
abstract

Questo rapporto intende contribuire all’analisi e discussione sulla riforma del sistema italiano di long-term care (LTC) attraverso una stima della spesa necessaria a finanziare la nuova Prestazione Universale per la Non Autosufficienza, prevista dall’articolo 4 della legge 33/2023. Il rapporto è articolato in tre parti. La prima fornisce una stima sintetica della spesa necessaria all’implementazione della Prestazione Universale a partire da come questa è stata disegnata nella legge. Le parti successive presentano le relazioni tecniche. La seconda parte presenta una stima dell’entità del fabbisogno assistenziale a cui la Prestazione Universale dovrebbe rispondere. La terza parte illustra nel dettaglio i contenuti della stima economica.

2024 - What remains after the money ends? Evidence on whether admission reductions continued following the largest health and social care integration programme in England [Articolo su rivista]
Wattal, Vasudha; Checkland, Katherine; Sutton, Matt; Morciano, Marcello
abstract

We study the long term effects on hospital activity of a three year national integration programme. We use administrative data spanning from 24 months before to 22 months after the programme, to estimate the effect of programme discontinuation using difference-in-differences method. Our results show that after programme discontinuation, emergency admissions were slower to increase in Vanguard compared to non-Vanguard sites. These effects were heterogeneous across sites, with greater reductions in care home Vanguard sites and concentrated among the older population. Care home Vanguards showed significant reductions beginning early in the programme but falling away more rapidly after programme discontinuation. Moreover, there were greater reductions for sites performing poorly before the programme. Overall, this suggests the effects of the integration programme might have been lagged but transitory, and more reliant on continued programme support.

2023 - A typology of integrated care policies in the care home sector: A policy document analysis [Articolo su rivista]
Simpson, Glenn; Entwistle, Charlotte; Short, Andrea D; Morciano, Marcello; Stokes, Jonathan
abstract

BackgroundHealth and social care systems in many countries have begun to trial and adopt "integrated" approaches. Yet, the significant role care homes play within the health and social care system is often understated. A key first step to identifying the care home integration interventions that are most (cost-)effective is the ability to precisely identify and record what has been implemented, where, and when-a "policy map." MethodsTo address gaps relating to the identification and recording of (cost-)effective integrated care home interventions, we developed a new typology tool. We conducted a policy mapping exercise in a devolved region of England-Greater Manchester (GM). Specifically, we carried out systematic policy documentary searches and extracted a range of qualitative data relating to integrated health and social care initiatives in the GM region for care homes. The data were then classified according to existing national ambitions for England as well as a generic health systems framework to illustrate gaps in existing recording tools and to iteratively develop a novel approach. ResultsA combined total of 124 policy documents were identified and screened, in which 131 specific care home integration initiatives were identified. Current initiatives emphasized monitoring quality in care homes, workforce training, and service delivery changes (such as multi-disciplinary teams). There was comparatively little emphasis on financing or other incentive changes to stimulate provider behavior for the care home setting. We present a novel typology for capturing and comparing care home integration policy initiatives, largely conceptualizing which part of the system or specific transition point the care home integration is targeting, or whether there is a broader cross-cutting system intervention being enacted, such as digital or financial interventions. ConclusionsOur typology builds on the gaps in current frameworks, including previous lack of specificity to care homes and lack of adaptability to new and evolving initiatives internationally. It could provide a useful tool for policymakers to identify gaps in the implementation of initiatives within their own areas, while also allowing researchers to evaluate what works most effectively and efficiently in future research based on a comprehensive policy map.

2023 - Analysing changes to the flow of public funding within local health and care systems: An adaptation of the System of Health Accounts framework to a local health system in England [Articolo su rivista]
Moss, C.; Anselmi, L.; Morciano, M.; Munford, L.; Stokes, J.; Sutton, M.
abstract

Financial flows relating to health care are routinely analysed at national and international level. They have rarely been systematically analysed at local level, despite sub-national variation due to population needs and decisions enacted by local organisations. We illustrate an adaptation of the System of Health Accounts framework to map the flow of public health and care funding within local systems, with an application for Greater Manchester (GM), an area in England which agreed a health and social care devolution deal with the central government in 2016. We analyse how financial flows changed in GM during the four years post-devolution, and whether spending was aligned with local ambitions to move towards prevention of ill-health and integration of health and social care. We find that GM decreased spending on public health by 15%, and increased spending on general practice by 0.1% in real terms. The share of total local expenditure paid to NHS Trusts for general and acute services increased from 70.3% to 71.6%, while that for community services decreased from 11.7% to 10.3%. Results suggest that GM may have experienced challenges in redirecting resources towards their goals. Mapping financial flows at a local level is a useful exercise to examine whether spending is aligned with system goals and highlight areas for further investigation.

2023 - Banning volume discounts to curb excessive consumption: A cautionary tale [Articolo su rivista]
Bokhari, Farasat A. S.; Dobson, Paul W.; Morciano, Marcello; Suhrcke, Marc
abstract

Volume discounts encourage consumers to buy more. Banning such discounts should then lead to consumers buying less. This is the thinking behind banning multiple-unit discounts, including multibuy price promotions, to curb excessive harmful consumption of alcohol and high-fat, -sugar, and -salt (HFSS) foods. However, our analysis questions the validity of this thinking, which ignores the possible restraining effect of volume discounts. We find that such a ban for retailing alcohol in Scotland increased rather than reduced sales. Retailers switched to using more straight (single-unit) discounts, which encouraged high-consumption households to increase their shopping frequency and buy more.

2023 - Correlations between parameters of glycaemic variability and foetal growth, neonatal hypoglycaemia and hyperbilirubinemia in women with gestational diabetes [Articolo su rivista]
Blasi, Immacolata; Daolio, Jessica; Pugni, Valeria; Comitini, Giuseppina; Morciano, Marcello; Grassi, Giorgio; Todros, Tullia; Gargano, Giancarlo; Aguzzoli, Lorenzo
abstract

: The diagnosis of gestational diabetes mellitus (GDM) is important to prevent maternal and neonatal complications. This study aimed to investigate the feasibility of parameters of glycaemic variability to predict neonatal complications in women with GDM. A retrospective study was conducted on pregnant women tested positive at the oral glucose tolerance test (OGTT) during 16-18 or 24-28 weeks of gestation. Glycaemic measures were extracted from patients' glucometers and expanded to obtain parameters of glycaemic variability. Data on pregnancy outcomes were obtained from clinical folders. Descriptive group-level analysis was used to assess trends in glycaemic measures and foetal outcomes. Twelve patients were included and analysed, accounting for 111 weeks of observations. The analysis of trends in parameters of glycaemic variability showed spikes of glycaemic mean, high blood glucose index and J-index at 30-31 weeks of gestation for cases with foetal macrosomia, defined as foetal growth >90° percentile, neonatal hypoglycaemia and hyperbilirubinemia. Specific trends in parameters of glycaemic variability observed at third trimester correlate with foetal outcomes. Further research is awaited to provide evidence that monitoring of glycaemic variability trends could be more clinically informative and useful than standard glycaemic checks to manage women with GDM at delivery.

2023 - The Relationship between the Prevalence of the Urgent and Emergency Care Vanguard Participance and Delayed Transfers of Care in English Local Authorities [Articolo su rivista]
Malisauskaite, Gintare; Jones, Karen; Lau, Yiu-Shing; Sutton, Matthew; Checkland, Katherine; Morciano, Marcello
abstract

This paper examines the relationship between the prevalence of the urgent and emergency care vanguard (UEC) at the local authority level and their delayed transfers of care (DTOC) rates in England. We created a novel measure of exposure to UEC vanguards based on the residence of patients who used UEC partner hospitals, and we group it by the level of exposure (high, medium, low, none). We use this measure to estimate the effect of UEC vanguards on DTOC rates and then on DTOC rates by sector and a range of reasons associated with the delay. The analysis was run at the local authority level (LA) using quarterly data from NHS England for 150 English LAs from the years 2012–2017. We find a statistically significant UEC exposure effect of around 0.3% reduction in total DTOC to a 1% increase of UEC exposure (equivalent to 775 DTOC days per local authority per quarter in high UEC exposure areas), a result robust to various specification checks. Nonacute sector DTOC was found to be more responsive to UEC vanguards in comparison to acute sector DTOC (0.4% and 0.3% reductions, respectively, to every 1% of UEC exposure). DTOC due to social care was particularly responsive to UEC exposure (0.7% reduction to 1% exposure). DTOC reasons associated with the highest impact of UEC exposure were as follows: awaiting a care package at own home, waiting for further NHS nonacute care, and completion of assessment (reductions of 0.5%, 0.3%, and 0.3% to 1% exposure, respectively). All three reasons were originally associated with the largest number of DTOC days. These findings further advocate for UEC vanguards having been successful at alleviating the pressure on hospitals related to DTOC.

2023 - The use and impact of digital COVID-19 tracking in adult social care: a prospective cohort study of care homes in Greater Manchester [Articolo su rivista]
Ullah, A.; Whittaker, W.; Bradley, F.; Nelson, P. A.; Dowding, D.; Morciano, M.; Cullum, N.
abstract

Background: To support proactive care during the coronavirus pandemic, a digital COVID-19 symptom tracker was deployed in Greater Manchester (UK) care homes. This study aimed to understand what factors were associated with the post-uptake use of the tracker and whether the tracker had any effects in controlling the spread of COVID-19. Methods: Daily data on COVID-19, tracker uptake and use, and other key indicators such as staffing levels, the number of staff self-isolating, availability of personal protective equipment, bed occupancy levels, and any problems in accepting new residents were analysed for 547 care homes across Greater Manchester for the period April 2020 to April 2021. Differences in tracker use across local authorities, types of care homes, and over time were assessed using correlated effects logistic regressions. Differences in numbers of COVID-19 cases in homes adopting versus not adopting the tracker were compared via event design difference-in-difference estimations. Results: Homes adopting the tracker used it on 44% of days post-adoption. Use decreased by 88% after one year of uptake (odds ratio 0.12; 95% confidence interval 0.06-0.28). Use was highest in the locality initiating the project (odds ratio 31.73; 95% CI 3.76-268.05). Care homes owned by a chain had lower use (odds ratio 0.30; 95% CI 0.14-0.63 versus single ownership care homes), and use was not associated with COVID-19 or staffing levels. Tracker uptake had no impact on controlling COVID-19 spread. Staff self-isolating and local area COVID-19 cases were positively associated with lagged COVID-19 spread in care homes (relative risks 1.29; 1.2-1.4 and 1.05; 1.0-1.1, respectively). Conclusions: The use of the COVID-19 symptom tracker in care homes was not maintained except in Locality 1 and did not appear to reduce the COVID-19 spread. COVID-19 cases in care homes were mainly driven by care home local-area COVID-19 cases and infections among the staff members. Digital deterioration trackers should be co-produced with care home staff, and local authorities should provide long-term support in their adoption and use.

2022 - Effects of chain ownership and private equity financing on quality in the English care home sector: retrospective observational study [Articolo su rivista]
Patwardhan, Sharvari; Sutton, Matthew; Morciano, Marcello
abstract

Background the structure of care homes markets in England is changing with the emergence of for-profit homes organised in chains and financed by private equity. Previous literature shows for-profit homes were rated lower quality than not-for-profit homes when inspected by the national regulator, but has not considered new forms of financing. Objectives to examine whether financing and organisation of care homes is associated with regulator assessments of quality. Methods retrospective observational study of the Care Quality Commission’s ratings of 10,803 care homes providing services to older people as of January 2020. We used generalised ordered logistic models to assess whether ratings differed between not-for-profit and for-profit homes categorised into three groups: (i) chained ownership, financed by private equity; (ii) chained ownership, not financed by private equity and (iii) independent ownership. We compared Overall and domain (caring, effective, responsive, safe, well-led) ratings adjusted for care home size, age and location. Results all three for-profit ownership types had lower average overall ratings than not-for-profit homes, especially independent (6.8% points (p.p.) more likely rated as ‘Requires Improvement/Inadequate’, 95% CI: 4.7–8.9) and private equity chains (6.6 p.p. more likely rated as ‘Requires Improvement/Inadequate’, 95% CI: 2.9–10.2). Independent homes scored better than private equity chains in the safe, effective and responsive domains but worst in the well-led domain. Discussion private equity financing and independent for-profit ownership are associated with lower quality. The consequences of the changing care homes market structure for quality of services should be monitored.

2022 - Estimating the additional costs of living with a disability in the United Kingdom between 2013 and 2016 [Articolo su rivista]
Schuelke, L.; Munford, L.; Morciano, M.
abstract

In the United Kingdom, more than 20% of the population live with a disability. Past evidence shows that being disabled is associated with functional limitations that often cause social exclusion and poverty. Therefore, it is necessary to analyse the connection between disability and poverty. This paper examines whether households with disabled members face extra costs of living to attain the same standard of living as their peers without disabled members. The modelling framework is based on the standard of living approach which estimates the extra income required to close the gap between households with and without disabled members. We apply an ordered logit regression to data from the Family Resources Survey between 2013 and 2016 to analyse the relationship between standard of living, income, and disability, conditional on other explanatory variables. We find that households with disabled members face considerable extra costs that go beyond the transfer payment of the government. The average household with disabled members saw their weekly extra costs continually increase from £293 in 2013 to £326 in 2016 [2020 prices]. Therefore, the government needs to adjust welfare policies to address the problem of extra costs faced by households with disabled members.

2022 - Excess years of life lost to COVID-19 and other causes of death by sex, neighbourhood deprivation, and region in England and Wales during 2020: A registry-based study [Articolo su rivista]
Kontopantelis, Evangelos; (Mamas A), Mamas; (Roger T), Webb; Castro, Ana; (Martin K), Rutter; (Chris P), Gale; (Darren M), Ashcroft; Pierce, Matthias; (Kathryn M), Abel; Price, Gareth; G C), Corinne Faivre-Finn (Van Spall) (Harriette; (Michelle M), Graham; Morciano, Marcello; (Glen P), Martin; Sutton, Matt; Doran, Tim
abstract

BackgroundDeaths in the first year of the Coronavirus Disease 2019 (COVID-19) pandemic in England and Wales were unevenly distributed socioeconomically and geographically. However, the full scale of inequalities may have been underestimated to date, as most measures of excess mortality do not adequately account for varying age profiles of deaths between social groups. We measured years of life lost (YLL) attributable to the pandemic, directly or indirectly, comparing mortality across geographic and socioeconomic groups.Methods and findingsWe used national mortality registers in England and Wales, from 27 December 2014 until 25 December 2020, covering 3,265,937 deaths. YLLs (main outcome) were calculated using 2019 single year sex-specific life tables for England and Wales. Interrupted time-series analyses, with panel time-series models, were used to estimate expected YLL by sex, geographical region, and deprivation quintile between 7 March 2020 and 25 December 2020 by cause: direct deaths (COVID-19 and other respiratory diseases), cardiovascular disease and diabetes, cancer, and other indirect deaths (all other causes). Excess YLL during the pandemic period were calculated by subtracting observed from expected values. Additional analyses focused on excess deaths for region and deprivation strata, by age-group. Between 7 March 2020 and 25 December 2020, there were an estimated 763,550 (95% CI: 696,826 to 830,273) excess YLL in England and Wales, equivalent to a 15% (95% CI: 14 to 16) increase in YLL compared to the equivalent time period in 2019. There was a strong deprivation gradient in all-cause excess YLL, with rates per 100,000 population ranging from 916 (95% CI: 820 to 1,012) for the least deprived quintile to 1,645 (95% CI: 1,472 to 1,819) for the most deprived. The differences in excess YLL between deprivation quintiles were greatest in younger age groups; for all-cause deaths, a mean of 9.1 years per death (95% CI: 8.2 to 10.0) were lost in the least deprived quintile, compared to 10.8 (95% CI: 10.0 to 11.6) in the most deprived; for COVID-19 and other respiratory deaths, a mean of 8.9 years per death (95% CI: 8.7 to 9.1) were lost in the least deprived quintile, compared to 11.2 (95% CI: 11.0 to 11.5) in the most deprived. For all-cause mortality, estimated deaths in the most deprived compared to the most affluent areas were much higher in younger age groups, but similar for those aged 85 or over. There was marked variability in both all-cause and direct excess YLL by region, with the highest rates in the North West. Limitations include the quasi-experimental nature of the research design and the requirement for accurate and timely recording.ConclusionsIn this study, we observed strong socioeconomic and geographical health inequalities in YLL, during the first calendar year of the COVID-19 pandemic. These were in line with long-standing existing inequalities in England and Wales, with the most deprived areas reporting the largest numbers in potential YLL.

2022 - Has COVID-19 changed carer's views of health and care integration in care homes? A sentiment difference-in-difference analysis of on-line service reviews [Articolo su rivista]
Almorox, E. G.; Stokes, J.; Morciano, M.
abstract

Closer integration of health and social care is a policy priority in many countries. The COVID-19 pandemic has reinforced the necessity of joining up health and social care systems, especially in care home settings. However, the meaning and perceived importance of integration for residents’ and carers’ experience is unclear and we do not know whether it has changed during the pandemic. Using unique data from on-line care home service reviews, we combined multiple methods. We used Natural Language Processing with supervised machine learning to construct a measure of sentiment for care home residents' and their relatives’ (measured by AFINN score). Difference-in-difference analysis was used to examine whether experiencing integrated care altered these sentiments by comparing changes in sentiment in reviews related to integration (containing specific terms) to those which were not. Finally, we used network analysis on post-estimation results to assess which specific attributes stakeholders focus on most when detailing their most/least positive experiences of health and care integration in care homes, and whether these attributes changed over the pandemic. Reviews containing integration words were more positive than reviews unrelated to integration in the pre-pandemic period (about 2.3 points on the AFINN score) and remained so during the first year of the pandemic. Overall positive sentiment increased during the COVID-19 period (average by +1.1 points), mainly in reviews mentioning integration terms at the beginning of the first (+2.17, p-value 0.175) and second waves (+3.678, p-value 0.027). The role of care home staff was pivotal in both positive and negative reviews, with a shift from aspects related to care in pre-pandemic to information services during the pandemic, signalling their importance in translating integrated needs-based paradigms into policy and practice.

2022 - The relative effects of non-pharmaceutical interventions on wave one Covid-19 mortality: natural experiment in 130 countries [Articolo su rivista]
Stokes, J.; Turner, A. J.; Anselmi, L.; Morciano, M.; Hone, T.
abstract

Background: Non-pharmaceutical interventions have been implemented around the world to control Covid-19 transmission. Their general effect on reducing virus transmission is proven, but they can also be negative to mental health and economies, and transmission behaviours can also change voluntarily, without mandated interventions. Their relative impact on Covid-19 attributed mortality, enabling policy selection for maximal benefit with minimal disruption, is not well established due to a lack of definitive methods. Methods: We examined variations in timing and strictness of nine non-pharmaceutical interventions implemented in 130 countries and recorded by the Oxford COVID-19 Government Response Tracker (OxCGRT): 1) School closing; 2) Workplace closing; 3) Cancelled public events; 4) Restrictions on gatherings; 5) Closing public transport; 6) Stay at home requirements (‘Lockdown’); 7) Restrictions on internal movement; 8) International travel controls; 9) Public information campaigns. We used two time periods in the first wave of Covid-19, chosen to limit reverse causality, and fixed country policies to those implemented: i) prior to first Covid-19 death (when policymakers could not possibly be reacting to deaths in their own country); and, ii) 14-days-post first Covid-19 death (when deaths were still low, so reactive policymaking still likely to be minimal). We then examined associations with daily deaths per million in each subsequent 24-day period, which could only be affected by the intervention period, using linear and non-linear multivariable regression models. This method, therefore, exploited the known biological lag between virus transmission (which is what the policies can affect) and mortality for statistical inference. Results: After adjusting, earlier and stricter school (− 1.23 daily deaths per million, 95% CI − 2.20 to − 0.27) and workplace closures (− 0.26, 95% CI − 0.46 to − 0.05) were associated with lower Covid-19 mortality rates. Other interventions were not significantly associated with differences in mortality rates across countries. Findings were robust across multiple statistical approaches. Conclusions: Focusing on ‘compulsory’, particularly school closing, not ‘voluntary’ reduction of social interactions with mandated interventions appears to have been the most effective strategy to mitigate early, wave one, Covid-19 mortality. Within ‘compulsory’ settings, such as schools and workplaces, less damaging interventions than closing might also be considered in future waves/epidemics.

2021 - Comparison of the impact of two national health and social care integration programmes on emergency hospital admissions [Articolo su rivista]
Morciano, M.; Checkland, K.; Durand, M. A.; Sutton, M.; Mays, N.
abstract

Background: Policy-makers expect that integration of health and social care will improve user and carer experience and reduce avoidable hospital use. [We] evaluate the impact on emergency hospital admissions of two large nationally-initiated service integration programmes in England: the Pioneer (November 2013 to March 2018) and Vanguard (January 2015 to March 2018) programmes. The latter had far greater financial and expert support from central agencies. Methods: Of the 206 Clinical Commissioning Groups (CCGs) in England, 51(25%) were involved in the Pioneer programme only, 22(11%) were involved in the Vanguard programme only and 13(6%) were involved in both programmes. We used quasi-experimental methods to compare monthly counts of emergency admissions between four groups of CCGs, before and after the introduction of the two programmes. Results: CCGs involved in the programmes had higher monthly hospital emergency admission rates than non-participants prior to their introduction [7.9 (95% CI:7.8–8.1) versus 7.5 (CI: 7.4–7.6) per 1000 population]. From 2013 to 2018, there was a 12% (95% CI:9.5–13.6%) increase in emergency admissions in CCGs not involved in either programme while emergency admissions in CCGs in the Pioneer and Vanguard programmes increased by 6.4% (95% CI: 3.8–9.0%) and 8.8% (95% CI:4.5–13.1%), respectively. CCGs involved in both initiatives experienced a smaller increase of 3.5% (95% CI:-0.3–7.2%). The slowdown largely occurred in the final year of both programmes. Conclusions: Health and social care integration programmes can mitigate but not prevent rises in emergency admissions over the longer-term. Greater financial and expert support from national agencies and involvement in multiple integration initiatives can have cumulative effects.

2021 - Determinants of bicycle commuting and the effect of bicycle infrastructure investment in London: Evidence from UK census microdata [Articolo su rivista]
Martin, A.; Morciano, M.; Suhrcke, M.
abstract

Worldwide, concern about physical inactivity and excessive car dependence has encouraged ambitious targets and policies to promote cycling. But policy making is hindered by limited knowledge about why cycling prevalence and trends vary greatly between different geographic areas (e.g. in London (UK) <1% cycle to work in Harrow compared to>15 % in Hackney) and individuals (e.g. by age or gender). The role of cycle infrastructure investment in explaining part of these patterns and trends is also unknown. We linked individual-level data on 317,117 London commuters (including 11,199 cyclists) in the 2001 and 2011 UK census to relevant geographic data, including on area-level cycling infrastructure investment during the period. Whilst cycle commuting increased over time on average, concentration curves and indices demonstrated that in contrast with England as a whole, cycling in London shifted from being dominated by commuters with lower socioeconomic status to commuters with higher socioeconomic status. In our first set of regression analyses, we showed that observed differences and time trends in cycling prevalence were partially explained by area-level differences in topography, greenspace, footpaths and crime levels and by differences and changes in population structures. In the second, we conducted a cost-effectiveness analysis which showed that expenditure on cycling infrastructure was associated with increased cycling at a marginal rate of £4915 per additional commuter cyclist, with some variation between groups: ethnic minorities were more responsive, and females, older people and those with lower socioeconomic status appeared less responsive. If planned increases in expenditure in England for the period 2020−25 were as cost-effective, and were sustained for the whole decade, our study suggests that commuter cycling prevalence could increase in England by 0.5 to 1.1 percentage points (this equates to a 16% to 34% increase in commuter cycling prevalence if compared to 2011 levels). More research is necessary to assess the impact on broader measures of cycling, active travel and overall physical activity, and to determine whether such expenditure constitutes good or equitable value for money.

2021 - Excess deaths from COVID-19 and other causes by region, neighbourhood deprivation level and place of death during the first 30 weeks of the pandemic in England and Wales: A retrospective registry study [Articolo su rivista]
Kontopantelis, E.; Mamas, M. A.; Webb, R. T.; Castro, A.; Rutter, M. K.; Gale, C. P.; Ashcroft, D. M.; Pierce, M.; Abel, K. M.; Price, G.; Faivre-Finn, C.; Van Spall, H. G. C.; Graham, M. M.; Morciano, M.; Martin, G. P.; Doran, T.
abstract

Background: Excess deaths during the COVID-19 pandemic compared with those expected from historical trends have been unequally distributed, both geographically and socioeconomically. Not all excess deaths have been directly related to COVID-19 infection. We investigated geographical and socioeconomic patterns in excess deaths for major groups of underlying causes during the pandemic. Methods: Weekly mortality data from 27/12/2014 to 2/10/2020 for England and Wales were obtained from the Office of National Statistics. Negative binomial regressions were used to model death counts based on pre-pandemic trends for deaths caused directly by COVID-19 (and other respiratory causes) and those caused indirectly by it (cardiovascular disease or diabetes, cancers, and all other indirect causes) over the first 30 weeks of the pandemic (7/3/2020–2/10/2020). Findings: There were 62,321 (95% CI: 58,849 to 65,793) excess deaths in England and Wales in the first 30 weeks of the pandemic. Of these, 46,221 (95% CI: 45,439 to 47,003) were attributable to respiratory causes, including COVID-19, and 16,100 (95% CI: 13,410 to 18,790) to other causes. Rates of all-cause excess mortality ranged from 78 per 100,000 in the South West of England and in Wales to 130 per 100,000 in the West Midlands; and from 93 per 100,000 in the most affluent fifth of areas to 124 per 100,000 in the most deprived. The most deprived areas had the highest rates of death attributable to COVID-19 and other indirect deaths, but there was no socioeconomic gradient for excess deaths from cardiovascular disease/diabetes and cancer. Interpretation: During the first 30 weeks of the COVID-19 pandemic there was significant geographic and socioeconomic variation in excess deaths for respiratory causes, but not for cardiovascular disease, diabetes and cancer. Pandemic recovery plans, including vaccination programmes, should take account of individual characteristics including health, socioeconomic status and place of residence. Funding: None.

2021 - Excess mortality for care home residents during the first 23 weeks of the COVID-19 pandemic in England: a national cohort study [Articolo su rivista]
Morciano, M.; Stokes, J.; Kontopantelis, E.; Hall, I.; Turner, A. J.
abstract

Background: To estimate excess mortality for care home residents during the COVID-19 pandemic in England, exploring associations with care home characteristics. Methods: Daily number of deaths in all residential and nursing homes in England notified to the Care Quality Commission (CQC) from 1 January 2017 to 7 August 2020. Care home-level data linked with CQC care home register to identify home characteristics: client type (over 65s/children and adults), ownership status (for-profit/not-for-profit; branded/independent) and size (small/medium/large). Excess deaths computed as the difference between observed and predicted deaths using local authority fixed-effect Poisson regressions on pre-pandemic data. Fixed-effect logistic regressions were used to model odds of experiencing COVID-19 suspected/confirmed deaths. Results: Up to 7 August 2020, there were 29,542 (95% CI 25,176 to 33,908) excess deaths in all care homes. Excess deaths represented 6.5% (95% CI 5.5 to 7.4%) of all care home beds, higher in nursing (8.4%) than residential (4.6%) homes. 64.7% (95% CI 56.4 to 76.0%) of the excess deaths were confirmed/suspected COVID-19. Almost all excess deaths were recorded in the quarter (27.4%) of homes with any COVID-19 fatalities. The odds of experiencing COVID-19 attributable deaths were higher in homes providing nursing services (OR 1.8, 95% CI 1.6 to 2.0), to older people and/or with dementia (OR 5.5, 95% CI 4.4 to 6.8), amongst larger (vs. small) homes (OR 13.3, 95% CI 11.5 to 15.4) and belonging to a large provider/brand (OR 1.2, 95% CI 1.1 to 1.3). There was no significant association with for-profit status of providers. Conclusions: To limit excess mortality, policy should be targeted at care homes to minimise the risk of ingress of disease and limit subsequent transmission. Our findings provide specific characteristic targets for further research on mechanisms and policy priority.

2021 - Inequalities in the distribution of the general practice workforce in England: A practice-level longitudinal analysis [Articolo su rivista]
Nussbaum, C.; Massou, E.; Fisher, R.; Morciano, M.; Harmer, R.; Ford, J.
abstract

Background: In England, demand for primary care services is increasing and GP shortages are widespread. Recently introduced primary care networks (PCNs) aim to expand the use of additional practice-based roles such as physician associates (PAs), pharmacists, paramedics, and others through financial incentives for recruitment of these roles. Inequalities in general practice, including additional roles, have not been examined in recent years, which is a meaningful gap in the literature. Previous research has found that workforce inequalities are associated with health outcome inequalities. Aim: To examine recent trends in general practice workforce inequalities. Design & setting: A longitudinal study using quarterly General Practice Workforce datasets from 2015–2020 in England. Method: The slope indices of inequality (SIIs) for GPs, nurses, total direct patient care (DPC) staff, PAs, pharmacists, and paramedics per 10 000 patients were calculated quarterly, and plotted over time, with and without adjustment for patient need. Results: Fewer GPs, total DPC staff, and paramedics per 10 000 patients were employed in more deprived areas. Conversely, more PAs and pharmacists per 10 000 patients were employed in more deprived areas. With the exception of total DPC staff, these observed inequalities widened over time. The unadjusted analysis showed more nurses per 10 000 patients employed in more deprived areas. These values were not significant after adjustment but approached a more equal or pro-poor distribution over time. Conclusion: Significant workforce inequalities exist and are even increasing for several key general practice roles, with workforce shortages disproportionately affecting more deprived areas. Policy solutions are urgently needed to ensure an equitably distributed workforce and reduce health inequities.

2021 - Market concentration, supply, quality and prices paid by local authorities in the English care home market [Articolo su rivista]
Espuny Pujol, Ferran; Hancock, Ruth; Hviid, Morten; Morciano, Marcello; Pudney, Stephen
abstract

We investigate the impact of exogenous local conditions which favor high market concentration on supply, price and quality in local markets for care homes for older people in England. We extend the existing literature in: (i) considering supply capacity as a market outcome alongside price and quality; (ii) taking account of the chain structure of care home supply and differences between the nursing home and residential care home sectors; (iii) using an econometric approach based on reduced form relationships that treats market concentration as a jointly determined outcome of a complex market. We find that areas susceptible to a high degree of market concentration tend to have greatly restricted supply of care home places and (to a lesser extent) a higher average public cost, than areas susceptible to low degree of market concentration. There is no significant evidence that conditions favoring high market concentration affect average care home quality.

2021 - Trends in survival of older care home residents in England: A 10-year multi-cohort study [Articolo su rivista]
Espuny Pujol, F.; Hancock, R.; Morciano, M.
abstract

Increases in longevity combined with a policy emphasis on caring for older people in their own homes could have widened or narrowed the survival gap between care home and community-dwelling resident older people. Knowledge of pre-COVID-19 trends in this gap is needed to assess the longer-term impacts of the pandemic. We provide evidence for England on recent trends in 1, 2 and 3-year mortality amongst care home residents aged 65+ compared with similar community-dwelling residents. We use the Clinical Practice Research Datalink, a nationally representative primary care database. For each of the ten years from 2006 to 2015, care home and community-dwelling residents aged 65+ were identified and matched in the ratio 1:3, according to age, gender, area deprivation and region. Cox survival analyses were used to estimate mortality risks for care home residents in comparison with similar community-dwelling people, adjusting for age, gender, area deprivation and region. The study sample consisted of ten overlapping cohorts averaging 5495 care home residents per cohort. Adjusted mortality risks increased over the study period for care home residents while decreasing slightly for matched community-dwelling residents. The relative risks (RRs) of mortality associated with care home residence were higher for younger ages and shorter follow-up periods, in all years. Over the decade, the RRs increased, most at younger ages and for shorter follow-up periods (e.g. for the age group 65–74 years, 1-year average RR increased by 61% from 5.4 to 8.8, while for those aged 85–94 years and over, 3-year RR increased by 22% from 1.3 to 1.6). Thus the survival gap between older care home and community-dwelling residents has been widening, especially at younger ages. In due course, it will be possible to establish to what extent the COVID-19 pandemic has resulted in further growth in this gap.

2020 - Exploring links between early adversities and later outcomes for children adopted from care: Implications for planning post adoption support [Articolo su rivista]
Neil, Elsbeth; Morciano, Marcello; Young, Julie; Hartley, Louise
abstract

This study explored how child maltreatment, alongside a range of other variables, predicted adverse outcomes for children adopted from the foster care system in England. The participants were 319 adoptive parents who completed an in-depth online survey about their most recently adopted child. The mean age of children at placement for adoption was 28 months (range 0–11 years) and their ages at the time of the survey ranged from 0 years to 17 years (mean ¼ 7 years). Detailed information was collected about children’s backgrounds, including their experiences in the birth family and the care system before adoption. Adoptive parents also reported on how well children were getting on in a range of areas of functioning and how well they felt the adoption was going overall. Child maltreatment and child adverse outcomes were modeled as two factors in a latent factor structural equation model. The relationship between these two factors was explored alongside a range of covariates. Associated with worse outcomes for children were potentially heritable factors (parental learning disability), the pre-birth environment (exposure to drugs or alcohol in utero) and the period between birth and moving to the adoptive family (higher levels of maltreatment, spending more than a year in care, having two or more foster placements). The child’s distress on moving from the foster home to the adoptive family was also highly significant in linking to poorer outcomes, suggesting the detrimental effect of poorly managed transitions. Implications for child welfare practices before and after adoption are discussed.

2020 - New integrated care models in England associated with small reduction in hospital admissions in longer-term: A difference-in-differences analysis [Articolo su rivista]
Morciano, M.; Checkland, K.; Billings, J.; Coleman, A.; Stokes, J.; Tallack, C.; Sutton, M.
abstract

Closer integration of health and social care services has become a cornerstone policy in many developed countries, but there is still debate over what population and service level is best to target. In England, the 2019 Long Term Plan for the National Health Service included a commitment to spread the integration prototypes piloted under the Vanguard `New Care Models’ programme. The programme, running from 2015 to 2018, was one of the largest pilots in English history, covering around 9 % of the population. It was largely intended to design prototypes aimed at reducing hospital utilisation by moving specialist care out of hospital into the community and by fostering coordination of health, care and rehabilitation services for (i) the whole population (‘population-based sites’), or (ii) care home residents (‘care home sites’). We evaluate and compare the efficacy of the population-based and care home site integrated care models in reducing hospital utilisation. We use area-level monthly counts of emergency admissions and bed-days obtained from administrative data using a quasi-experimental difference-in-differences design. We found that Vanguard sites had higher hospital utilisation than non-participants in the pre-intervention period. In the post-intervention period, there is clear evidence of a substantial increase in emergency admissions among non-Vanguard sites. The Vanguard integrated care programme slowed the rise in emergency admissions, especially in care home sites and in the third and final year. There was no significant reduction in bed-days. In conclusion, integrated care policies should not be relied upon to make large reductions in hospital activity in the short-run, especially for population-based models.

2020 - Variability in size and characteristics of primary care networks in England [Articolo su rivista]
Morciano, M.; Checkland, K.; Hammond, J.; Lau, Y. -S.; Sutton, M.
abstract

Background General practices in England have been encouraged by national policy to work together on a larger scale by creating primary care networks (PCNs). Policy guidance recommended that they should serve populations of 30 000-50 000 people to perform effectively. Aim To describe variation in the size and characteristics of PCNs and their populations. Design and setting Cross-sectional analysis in England. Method Using published information from January 2020, PCNs were identified that contained <30 000, between 30 000-50 000, and >50 000 people. Percentiles were calculated to describe variation in size and population characteristics. PCN composition within each commissioning region was also examined. Results In total, 6758 practices had formed 1250 PCNs. Seven hundred and twenty-six (58%) PCNs had the recommended population of 30 000-50 000 people. Eighty-four (7%) PCNs contained <30 000 people. Four hundred and forty (35%) PCNs contained >50 000 people. Thirty-four (3%) PCNs comprised just one practice and 77 (6%) PCNs contained >10 practices. Some PCNs contained more than double the proportions of older people and people with chronic conditions compared to other PCNs. More than half of the population were from very socioeconomically deprived areas in 172 (14%) PCNs. Only six (4%) of the 135 commissioning regions ensured all PCNs were in the recommended population range. All practices had joined a single PCN in three (2%) commissioning regions. Conclusion More than 40% of the PCNs were not of the recommended size, and there was substantial variation in their composition and characteristics. This high variability between PCNs is a risk to their future performance.

2019 - Cash-for-Care payments in Europe: changes in resources allocation [Articolo su rivista]
Morciano, Marcello; Gori, Cristiano
abstract

Resource allocation has been a main policy issue in cash-for-care schemes (CfCs) for older people in Europe since their inception. It regards how publicly funded care benefits and services are distributed among older people. The raising pressures of an ageing population and the tensions on the financial sustainability of welfare regimes in place have further exacerbated the relevance of this topic over the recent years. Nevertheless, comparative research so far has overlooked changes in resource allocation in CfCs over time. This article contributes to fill this gap, exploring changes in resource allocation of CfCs for older people in a sample of European countries-Austria, England, France, Germany, Italy, and The Netherlands-since the early '90s (or since the introduction of the scheme). It examines three analytical dimensions: (a) The mix of public services and benefits provided to older people (CfCs, community services in kind, residential care); (b) the level of CfCs coverage; and (c) its generosity. A combined view of these dimensions leads to the discussion of two dilemmas: How to allocate the resources devoted to CfCs in the light of the trade-off between its coverage and intensity? And, within the whole long-term care system, how to allocate resources between CfCs and services in kind?

2019 - Public Support for Older Disabled People: Evidence from the English Longitudinal Study of Ageing on Receipt of Disability Benefits and Social Care Subsidy [Articolo su rivista]
Hancock, R.; Morciano, M.; Pudney, S.
abstract

In England, state support for older people with disabilities consists of a national system of non-means-tested cash disability benefits and a locally administered means-tested system of social care. Evidence on how the combination of the two systems targets those in most need is lacking. We estimate a latent factor structural equation model of disability and receipt of one or both forms of support. The model integrates the measurement of disability and its influence on receipt of state support, allowing for the socio-economic gradient in disability, and adopts income and wealth constructs appropriate to each part of the model. We find that receipt of each form of support rises as disability increases, with a strong concentration on the most disabled, especially for local-authority-funded care. The overlap between the two programmes is confined to the most disabled. Less than half of recipients of local-authority-funded care also receive a disability benefit; a third of those in the top 10 per cent of the disability distribution receive neither form of support. Despite being non-means-tested, disability benefits display a degree of income and wealth targeting, as a consequence of the socio-economic gradient in disability and likely disability benefit claims behaviour. The scope for improving income/wealth targeting of disability benefits by means testing them, as some have suggested, is thus less than might be expected.

2018 - Care and State Pension Reform - Interactions between state pension and long-term care reforms: a summary of further findings [Bibliografia]
• Adams, J.; Curry, C.; Espuny Pujol, F.; Hancock, R.; Hu, B.; King, D.; Luheshi, S.; Morciano, M.; Pike, T.
abstract

2018 - Impact on alcohol purchasing of a ban on multi-buy promotions: a quasi-experimental evaluation comparing Scotland with England and Wales [Articolo su rivista]
Nakamura, Ryota; Suhrcke, Marc; Pechey, Rachel; Morciano, Marcello; Roland, Martin; Marteau, Theresa
abstract

AIMS: To evaluate the impact of the 2011 Scottish ban on multi-buy promotions of alcohol in retail stores. DESIGN AND SETTING: Difference-in-differences analysis was used to estimate the impact of the ban on the volume of alcohol purchased by Scottish households, compared with those in England and Wales, between January 2010 and June 2012. PARTICIPANTS: A total of 22 356 households in Scotland, England and Wales. MEASUREMENTS: Records of alcohol purchasing from each of four categories (beer and cider, wine, spirits and flavoured alcoholic beverages), as well as total volume of pure alcohol purchased. FINDINGS: Controlling for general time trends and household heterogeneity, there was no significant effect of the multi-buy ban in Scotland on volume of alcohol purchased either for the whole population or for individual socio-economic groups. There was also no significant effect on those who were large pre-ban purchasers of alcohol. Most multi-buys were for beer and cider or for wine. The frequency of shopping trips involving beer and cider purchases increased by 9.2% following the ban (P

2018 - Modelling ageing populations to 2030: Financing long-term care in England [Capitolo/Saggio]
Murphy, M.; Hancock, R.; Wittenberg, R.; Hu, B.; Morciano, M.; Comas-Herrera, A.
abstract

2018 - The Conservative Party manifesto proposal to include housing wealth in the means test for home care: how might it affect public spending on long-term care for older people? [Bibliografia]
Hancock, R; Hu, B; Wittenberg, R.; Morciano, M.
abstract

2016 - Disability and poverty in later life [Monografia/Trattato scientifico]
Hancock, Ruth; Morciano, Marcello; Pudney, Stephen
abstract

This report explores the relationship between disability and poverty amongthe older population. It emphasises the additional living costs that disabledpeople face, and the importance of taking disability costs into accountwhen making poverty assessments in the older population. The reportconsiders alternative directions of reform for the system of public supportfor older people with disabilities and casts doubt on some of thesuggestions that have been made for improving the targeting of publicsupport for older disabled people.

2015 - Birth-cohort trends in older-age functional disability and their relationship with socio-economic status: Evidence from a pooling of repeated cross-sectional population-based studies for the UK [Articolo su rivista]
Morciano, M.; Hancock, R. M.; Pudney, S. E.
abstract

We examine birth-cohort trends behind recent changes in the prevalence of functional disability in the older population living in private households in the United Kingdom (UK). By using three different socio-economic indicators available in the nationally representative cross-sectional data on older individuals interviewed between 2002 and 2012 in the Family Resource Survey (FRS) (96,733 respondents), we investigate the extent to which the overall trends have been more favourable among more advantaged than disadvantaged socioeconomic groups.Compared to the cohort of people born in 1924, successive cohorts of older men have lower odds of having at least one functional difficulty (FD), whereas no significant trend was found for women. Among people with at least one FD, however, the number of disabilities increases for each successive cohort of older women (incidence rate ratio 1.027, 95% confidence interval 1.023 to 1.031, P<0.001) and men (incidence rate ratio 1.028, 95% confidence interval 1.024 to 1.033, P<0.001). By allowing interactions between birth cohort and SES indicators, a significant increasing cohort trend in the number of reported FDs was found among older men and women at lower SES, whereas an almost stable pattern was observed at high SES. Our results suggest that the overall slightly increasing birth-cohort trend in functional difficulties observed among current cohorts of older people in the UK hides underlying increases among low SES individuals and a relative small reduction among high SES individuals. Further studies are needed to understand the causes of such trends and to propose appropriate interventions. However, if the SES differentials in trends in FDs observed in the past continue, this could have important implications for the future costs of the public system of care and support for people with care needs.

2015 - Disability Costs and Equivalence Scales in the Older Population in Great Britain [Articolo su rivista]
Morciano, M.; Hancock, R.; Pudney, S.
abstract

We use a standard of living (SoL) approach to estimate older people's disability costs, using data on 8000 individuals from the U.K. Family Resources Survey. We extend previous research in two ways. First, by allowing for a more flexible relationship between SoL and income, the structure of the estimated disability cost and equivalence scale is not dictated by a restrictive functional form assumption. Second, we allow for the latent nature of disability and SoL, addressing measurement error in the disability and SoL indicators in surveys. We find that disability costs are strongly related to severity of disability, and vary with income in absolute and proportionate terms. Older people above the median disability level require an extra £99 per week (2007 prices) on average to reach the SoL of an otherwise similar person at the median. Costs faced by older people in the highest decile of disability average £180.

2015 - Do household surveys give a coherent view of disability benefit targeting?: A multisurvey latent variable analysis for the older population in Great Britain [Articolo su rivista]
Hancock, R.; Morciano, M.; Pudney, S.; Zantomio, F.
abstract

We compare three major UK surveys, the British Household Panel Survey, Family Resources Survey and the English Longitudinal Study of Ageing, in terms of the picture that they give of the relationship between disability and receipt of the attendance allowance benefit. Using the different disability indicators that are available in each survey, we use a structural equation approach involving a latent concept of disability in which probabilities of receiving attendance allowance depend on disability. Despite major differences in design, once sample composition has been standardized through statistical matching, the surveys deliver similar results for the model of disability and receipt of attendance allowance. Provided that surveys offer a sufficiently wide range of disability indicators, the detail of disability measurement appears relatively unimportant.

2014 - Impact on alcohol purchasing of a ban on multi-buy promotions: A quasi-experimental evaluation comparing Scotland with England and Wales [Capitolo/Saggio]
Nakamura, R.; Suhrcke, M.; Pechey, R.; Morciano, M.; Roland, M.; Marteau, T. M.
abstract

Aims: To evaluate the impact of the 2011 Scottish ban on multi-buy promotions of alcohol in retail stores. Design and setting: Difference-in-differences analysis was used to estimate the impact of the ban on the volume of alcohol purchased by Scottish households, compared with those in England and Wales, between January 2010 and June 2012. Participants: A total of 22356 households in Scotland, England and Wales. Measurements: Records of alcohol purchasing from each of four categories (beer and cider, wine, spirits and flavoured alcoholic beverages), as well as total volume of pure alcohol purchased. Findings: Controlling for general time trends and household heterogeneity, there was no significant effect of the multi-buy ban in Scotland on volume of alcohol purchased either for the whole population or for individual socio-economic groups. There was also no significant effect on those who were large pre-ban purchasers of alcohol. Most multi-buys were for beer and cider or for wine. The frequency of shopping trips involving beer and cider purchases increased by 9.2% following the ban (P<0.01), while the number of products purchased on each trip decreased by 8.1% (P<0.01). For wine, however, these effects were not significant. Conclusions: Banning multi-buy promotions for alcohol in Scotland did not reduce alcohol purchasing in the short term. Wider regulation of price promotion and price may be needed to achieve this. © 2013 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

2013 - The role of care home fees in the public costs and distributional effects of potential reforms to care home funding for older people in England [Articolo su rivista]
Hancock, R.; Malley, J.; Wittenberg, R.; Morciano, M.; Pickard, L.; King, D.; Comas-Herrera, A.
abstract

In England, Local Authorities (LAs) contribute to the care home fees of two-thirds of care home residents aged 65+ who pass a means test. LAs typically pay fees below those faced by residents excluded from state support. Most proposals for reform of the means test would increase the proportion of residents entitled to state support. If care homes receive the LA fee for more residents, they might increase fees for any remaining self-funders. Alternatively, the LA fee might have to rise. We use two linked simulation models to examine how alternative assumptions on post-reform fees affect projected public costs and financial gains to residents of three potential reforms to the means test. Raising the LA fee rate to maintain income per resident would increase the projected public cost of the reforms by between 22% and 72% in the base year. It would reduce the average gain to care home residents by between 8% and 12%. Raising post-reform fees for remaining self-funders or requiring pre-reform self-funders to meet the difference between the LA and self-funder fees, reduces the gains to residents by 28-37%. For one reform, residents in the highest income quintile would face losses if the self-funder fee rises. © 2012 Cambridge University Press.

2012 - Attendance allowance and disability living allowance claimants in the older population: Is there a difference in their economic circumstances? [Articolo su rivista]
Hancock, R.; Morciano, M.; Pudney, S.
abstract

The UK Disability Living Allowance (DLA) is a non-means-tested cash benefit claimable only before age 65, although receipt can continue beyond 65. The similar Attendance Allowance (AA) can be claimed only from age 65 and in some cases is worth less than DLA. DLA is being replaced by Personal Independence Payment (PIP) which, like DLA, will have advantages over AA. These advantages are sometimes justified on grounds that DLA recipients have longer histories of disability and consequently lower incomes. Using detailed survey data we find no evidence of higher levels of income deprivation among older DLA than AA recipients. Copyright © The Policy Press, 2012.

2012 - CAPP_DYN: A Dynamic Microsimulation Model for the Italian Social Security System [Working paper]
Mazzaferro, C.; Morciano, M.
abstract

2012 - Differential mortality and redistribution in the Italian notional defined contribution system [Articolo su rivista]
Mazzaferro, C.; Morciano, M.; Savegnago, M.
abstract

In this paper, we adopt a financial measure (net present value ratio) to assess the extent of the redistribution of lifetime earnings operated by the introduction of a notional defined contribution (NDC) system in the Italian PAYGO system. Our simulations are based on a representative sample of the Italian population consisting of individuals born between 1975 and 2000. We identify three channels of redistribution: between genders (from men to women), along educational lines (from the less-well-educated to the highly educated) and between diverse lifetime-earnings quintiles (from the poor to the rich). This happens because certain groups of individuals systematically live shorter-than-average lives (men, the less well-educated and the poor), whereas others live longer-than-average lives (women, the highly educated and the rich) and, at the same time, the NDC system does not take into account such differences. Comparison between the old defined benefit system and the reformed NDC one shows that intergenerational fairness has improved sensibly but differences between gender and educational levels remained nearly the same. Sensitivity analysis and the consideration of survival pensions in our simulations confirm the general trends of our base case. © 2012 Cambridge University Press.

2011 - Estimation and Simulation of Earnings in IT-SILC [Working paper]
Ciani, E.; Morciano, M.
abstract

2011 - Estimation and Simulation of Earnings in IT-SILC [Working paper]
Ciani, E.; Morciano, M.
abstract

2011 - The Strengths and Failures of Incentive Mechanisms in Notional Defined Contribution Pension Systems [Articolo su rivista]
Marano, SALVATORE ANGELO; Mazzaferro, Carlo; Morciano, Marcello
abstract

2011 - The effect of lengthening life expectancy on future pension and long-term care expenditure in England, 2007 to 2032 [Articolo su rivista]
Malley, J.; Hancock, R.; Murphy, M.; Adams, J.; Wittenberg, R.; Comas-Herrera, A.; Curry, C.; King, D.; James, S.; Morciano, M.; Pickard, L.
abstract

2011 - Trends and dynamics in the Italian labour market. An empirical evaluation using RFL data, 1993-2007 [Working paper]
Flisi, S.; Morciano, M.
abstract

2011 - Trends and dynamics in the Italian labour market. An empirical evaluation using RFL data, 1993-2007 [Working paper]
Flisi, S.; Morciano, M.
abstract

2010 - A web-based tool for adjusting costs to a specific target currency and price year [Articolo su rivista]
Shemilt, Ian; Thomas, James; Morciano, Marcello
abstract

Objective:To develop a web-based tool to automate the adjustment of estimates of costs drawn from previously published or unpublished studies to a specified target currency and price yearMethods: A web-based tool was programmed using C#, utilising GDP deflator index values and Purchasing Power Parities conversion rates produced by the International Monetary Fund and the Organisation for Economic Co-operation and Development.Results: Version 1.0 is available at http://eppi.ioe.ac.uk/costconversion/default.aspxConclusions:The tool can be used as a first-line approach to cost adjustment in non-healthcare applications and as an optional approach in healthcare applications when use of more sophisticated methods is not feasible.

2010 - The Introduction of a Private Wealth Module in CAPP_DYN: an Overview [Working paper]
Mazzaferro, C.; Morciano, M.; Pisano, E.; Tedeschi, S.
abstract

2009 - I costi della lenta transizione al sistema contributivo: un’analisi distributiva [Working paper]
Morciano, M.; Mazzaferro, C.
abstract

2008 - Assessing The Implications of Long Term Care Policies in Italy: a Microsimulation Approach [Working paper]
Baldini, M.; Mazzaferro, C.; Morciano, M.
abstract

2008 - Assessing the implications of long-term care policies in Italy: a microsimulation approach [Articolo su rivista]
Baldini, Massimo; C., Mazzaferro; M., Morciano
abstract

This paper estimates the future characteristics of the long-term disabled in Italy and the evolution of total public expenditure for long-term care. The future dynamics of ltc expenditure in Italy is of particular relevance for two reasons: the limited and insufficientlevel of public expenditure currently targeted to the disabled, and the perspective in the next few decades of one of the most rapid ageing processes in the world.The analysis is carried out using a dynamic microsimulation model that estimates the evolution for the next five decades of the social and economic structure of the Italian population. After an analysis of the future structure of the pool of the disabled population, we consider two alternative hypotheses for the dynamics of public expenditure in ltc: the simple continuation of the current rules, and a significant increase in the generosity ofpublic schemes, in order to satisfy the mounting pressure coming from households. We also compute the implicit tax rates needed to raise the required resources.

2008 - CAPP_DYN: a dynamic microsimulation model for the Italian social security system [Working paper]
Mazzaferro, C.; Morciano, M.
abstract

Microsimulation allows to apply a set of deterministic or stochastic rules on a sample of micro-unit such as individuals, households, rms or institutions. A Dynamic Microsimulation Model (DMM) contains a set of rules aiming at projecting the likely socio-economic evolution of a representative sample of individuals throughout time. In this paper, we describe the simulation algorithms and the econom(etr)ic frameworks used in CAPP DYN, a population based DMM for the analysis of the inter- and intra-generational redistributive e ects of the Italian social security system. By including detailed rules that determine the eligibility to various social security bene ts, CAPP DYN is quali ed as a useful tool in assessing the long-run distributional e ects of the reforms approved in the Italian social security system.

2008 - Chi ha beneficiato delle riforme del nostro sistema di tax-benefit? Le ultime due legislature a confronto. [Capitolo/Saggio]
Baldini, Massimo; M., Morciano; S., Toso
abstract

Il lavoro analizza l'impatto sulla distribuzione del reddito dei principali provvedimenti di spesa e tassazione adottati in Italia nel corso delle due legislature 1996-2001 e 2001-2006.

2008 - Costi e argomenti. [Capitolo/Saggio]
Baldini, Massimo; C., Gori; C., Mazzaferro; M., Morciano
abstract

Simulazioni su varie alternative per incrementare l'offerta di servizi e trasferimenti ai non autosufficienti in Italia.

2008 - Integrazione tra dati censuari e dati di indagini sulla condizione economica delle famiglie per la costruzione di mappe della povertà locale e di modelli di valutazione delle politiche sociali locali [Working paper]
Morciano, M.; Silvestri, P.
abstract

2007 - Assessing the implications of long term care policies in Italy: a microsimulation approach [Working paper]
Baldini, M.; Morciano, M.; Mazzaferro, C.
abstract

2007 - Pension reforms, educational choices and the long term dynamic of the employment in Italy [Working paper]
Mazzaferro, C.; Morciano, M.
abstract

In this paper we use CAPP_DYN, a population based dynamic microsimulation model to simulate the Italian employed population during the period 2005-2050. We find that the more interesting changes will affect the composition rather than the level of the employed population. We investigate main factors that are at work (cohorts effects, educational choices and pension reforms). Finally we present some sensitivity analyses to test

2006 - Qualità della vita base della qualità del lavoro [Working paper]
Addabbo, T.; Facchinetti, G.; Morciano, M.; Picchio, A.; Pirotti, T.
abstract

2006 - Qualità della vita base della qualità del lavoro [Working paper]
Addabbo, Tindara; Facchinetti, Gisella; Morciano, M.; Picchio, Antonella; Pirotti, Tommaso
abstract

Il presente lavoro si è proposto di analizzare la formazione del benessere nella sua multidimensionalità fondandosi teoricamente su un approccio macro riproduttivo esteso. L’approccio scelto consente di evidenziare la rilevanza nella misurazione dei livelli di benessere di componenti non monetarie e analizza i livelli di benessere sia a livello individuale che a livello familiare. Un risultato collaterale dell’analisi è stato la costruzione, attraverso l’approccio combinato micro-macro, ispirato al metodo del propensity score matching, di un data set che contiene indicatori attinenti alle diverse dimensioni ritenute rilevanti per l’analisi del modello teorico di riferimento ottenuto integrando i microdati della Banca d’Italia sui ‘Bilanci delle famiglie Italiane’ del 2000 (IBFI) con un vettore di informazioni presenti nell’indagine ISTAT ‘Famiglie, soggetti sociali e condizioni dell’infanzia’ del 1998. La formazione del benessere e la sua misurazione ha richiesto, per mantenere la complessità richiesta dall’oggetto di analisi, l’uso di tecniche fuzzy e la costruzione di un sistema fuzzy esperto all’interno del quale sono confluiti gli assi delle condizioni di vita con riferimento sia alla dimensione individuale che alle dimensioni riguardanti il nucleo familiare. L’implementazione del sistema al data set integrato ha consentito di rilevare le differenze di genere nella formazione del benessere e di mostrare le diseguaglianze che l’attenzione alla sola dimensione familiare o alle sole componenti monetarie non consentiva di cogliere.

2006 - Stima della povertà a livello locale: i casi della Regione Toscana e delle Province di Modena e Trento [Working paper]
Ballini, F.; Betti, G.; Lemmi, A.; Marzadro, S.; Morciano, M.; Neri, L.; Sciclone, N.
abstract

2005 - Tributi locali e distribuzione del reddito nei comuni dell’Emilia Romagna [Working paper]
Morciano, M.
abstract

2005 - Un modello di microsimulazione a popolazione dinamica per la stima degli effetti distributivi della riforma pensionistica [Working paper]
Mazzaferro, C.; Morciano, M.
abstract

2005 - Un modello di microsimulazione a popolazione dinamica per la stima degli effetti distributivi della riforma pensionistica [Working paper]
Mazzaferro, C.; Morciano, M.
abstract

In questo lavoro utilizziamo un modello di microsimulazione a popolazione dinamica per stimare l’impatto sulla distribuzione dei redditi da pensione del progressivo passaggio alla regola contributiva nel periodo 2004-2050. Il modello, costruito con procedure di tipo probabilistico e su scenari demografici e macroeconomici esogeni, evidenzia come il giudizio sugli effetti distributivi delle riforme pensionistiche diventi più complesso quando a fianco dei tradizionali indicatori usati in questi anni (tasso interno di rendimento, net present value ratio, ricchezza pensionistica) se ne considerino altri più attenti alla distribuzione e alla dispersione dei redditi correnti. In particolare il modello evidenzia una forte caduta del rapporto tra pensione e salario medio, un consistente aumento del numero di pensioni da lavoro di importo molto basso, un deciso aumento della dispersione delle pensioni da lavoro ed il ruolo sempre più importante per il futuro dell’assegno sociale come strumento di contrasto delle disuguaglianze nella distribuzione dei redditi da pensione.