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Making governance work in the health care sector: evidence from a 'natural experiment' in Italy.

Nuti S, Vola F, Bonini A, Vainieri M - Health Econ Policy Law (2015)

Bottom Line: This paper examines the different governance models that the regions have adopted and investigates the performance evaluation systems (PESs) associated with them, focusing on the experience of a network of ten regional governments that share the same PES.Through an analysis of 14 indicators measured in 2007 and in 2012 for all the regions, the study examines how different performance evaluation models are associated with different health care performances and whether the network-shared PES has made any difference to the results achieved by the regions involved.The initial results support the idea that systematic benchmarking and public disclosure of data are powerful tools to guarantee the balanced and sustained improvement of the health care systems, but only if they are integrated with the regional governance mechanisms.

View Article: PubMed Central - PubMed

Affiliation: Laboratorio Management e Sanità,Institute of Management,Scuola Superiore Sant'Anna,Pisa,Italy.

ABSTRACT
The Italian Health care System provides universal coverage for comprehensive health services and is mainly financed through general taxation. Since the early 1990s, a strong decentralization policy has been adopted in Italy and the state has gradually ceded its jurisdiction to regional governments, of which there are twenty. These regions now have political, administrative, fiscal and organizational responsibility for the provision of health care. This paper examines the different governance models that the regions have adopted and investigates the performance evaluation systems (PESs) associated with them, focusing on the experience of a network of ten regional governments that share the same PES. The article draws on the wide range of governance models and PESs in order to design a natural experiment. Through an analysis of 14 indicators measured in 2007 and in 2012 for all the regions, the study examines how different performance evaluation models are associated with different health care performances and whether the network-shared PES has made any difference to the results achieved by the regions involved. The initial results support the idea that systematic benchmarking and public disclosure of data are powerful tools to guarantee the balanced and sustained improvement of the health care systems, but only if they are integrated with the regional governance mechanisms.

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Percentage of femur fractures operated on within two days.
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fig2: Percentage of femur fractures operated on within two days.

Mentions: PES measures results in quantitative terms and then assesses performance for 100 of the 160 indicators: excellent, good, sufficient, poor or very poor. These five evaluation tiers are associated with different colours, from dark green (excellent performance), to red (poor). Regions use the same reference standards for evaluation, based on the scientific literature, national standards or, where these are lacking, on the median of the 99 HAs. Figure 2, as an example, displays the indicator of femur fractures operated on within two days.Figure 2


Making governance work in the health care sector: evidence from a 'natural experiment' in Italy.

Nuti S, Vola F, Bonini A, Vainieri M - Health Econ Policy Law (2015)

Percentage of femur fractures operated on within two days.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4697307&req=5

fig2: Percentage of femur fractures operated on within two days.
Mentions: PES measures results in quantitative terms and then assesses performance for 100 of the 160 indicators: excellent, good, sufficient, poor or very poor. These five evaluation tiers are associated with different colours, from dark green (excellent performance), to red (poor). Regions use the same reference standards for evaluation, based on the scientific literature, national standards or, where these are lacking, on the median of the 99 HAs. Figure 2, as an example, displays the indicator of femur fractures operated on within two days.Figure 2

Bottom Line: This paper examines the different governance models that the regions have adopted and investigates the performance evaluation systems (PESs) associated with them, focusing on the experience of a network of ten regional governments that share the same PES.Through an analysis of 14 indicators measured in 2007 and in 2012 for all the regions, the study examines how different performance evaluation models are associated with different health care performances and whether the network-shared PES has made any difference to the results achieved by the regions involved.The initial results support the idea that systematic benchmarking and public disclosure of data are powerful tools to guarantee the balanced and sustained improvement of the health care systems, but only if they are integrated with the regional governance mechanisms.

View Article: PubMed Central - PubMed

Affiliation: Laboratorio Management e Sanità,Institute of Management,Scuola Superiore Sant'Anna,Pisa,Italy.

ABSTRACT
The Italian Health care System provides universal coverage for comprehensive health services and is mainly financed through general taxation. Since the early 1990s, a strong decentralization policy has been adopted in Italy and the state has gradually ceded its jurisdiction to regional governments, of which there are twenty. These regions now have political, administrative, fiscal and organizational responsibility for the provision of health care. This paper examines the different governance models that the regions have adopted and investigates the performance evaluation systems (PESs) associated with them, focusing on the experience of a network of ten regional governments that share the same PES. The article draws on the wide range of governance models and PESs in order to design a natural experiment. Through an analysis of 14 indicators measured in 2007 and in 2012 for all the regions, the study examines how different performance evaluation models are associated with different health care performances and whether the network-shared PES has made any difference to the results achieved by the regions involved. The initial results support the idea that systematic benchmarking and public disclosure of data are powerful tools to guarantee the balanced and sustained improvement of the health care systems, but only if they are integrated with the regional governance mechanisms.

Show MeSH
Related in: MedlinePlus