Exploring health outcomes by stochastic multicriteria acceptability analysis: An application to Italian regions

This paper introduces the Stochastic Multicriteria Acceptability Analysis (SMAA) in order to investigate the evolution of mortality rates in the Italian regions over the period 1990-2013. We propose to explore the overall outcome of health care by a Composite Index of mortality based on the combination of standardized mortality rates for seventeen different diseases. From a methodological standpoint, we propose to overcome the arbitrary nature of the weighting process, by using the SMAA, which is a methodology that allows to rank regions considering the whole set of possible vectors of weights. Moreover, we explore the spatial segregation in health using the multidimensional generalization of the Gini index, and introduce the multidimensional generalization of ANOGI. The unprecedented use of SMAA in evaluating the health sector allows to explore regional multidimensional paths beyond the order of importance given to the single dimensions. Our analysis shows that in the 24 years considered there has been no convergence path in terms of health care outcome in Italy, neither between nor within regions. (C) 2018 Elsevier B.V. Ali rights reserved.