The impact of regulatory compliance behavior on hazardous waste generation in European private healthcare facilities.

This study empirically evaluates whether the increasingly large numbers of private outpatient healthcare facilities (HCFs) within the European Union (EU) countries comply with the existing European waste legislation, and whether compliance with such legislation affects the fraction of healthcare waste (HCW) classified as hazardous. To that end, this study uses data collected by a large survey of more than 700 small private HCFs distributed throughout Portugal, a full member of the EU since 1986, where 50% of outpatient care is currently dominated by private operators. The collected data are then used to estimate a hurdle model, i.e. a statistical specification in which there are two processes: one is the process by which some HCFs generate zero or some positive fraction of hazardous HCW, and another is the process by which HCFs generate a specific positive fraction of hazardous HCW conditional on producing any. Taken together, the results show that although compliance with the law is far from ideal, it is the strongest factor influencing hazardous waste generation. In particular, it is found that higher compliance has a small and insignificant effect on the probability of generating (or reporting) positive amounts of hazardous waste, but it does have a large and significant effect on the fraction of hazardous waste produced, conditional on producing any, with a unit increase in the compliance rate leading to an estimated decrease in the fraction of hazardous HCW by 16.3 percentage points.