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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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The ‘dartboard’.
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Related In: Results  -  Collection

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fig3: The ‘dartboard’.

Mentions: In order to show the performance of each region or HA, a chart with the six dimensions is used (see Figure 3). The chart is also divided into five evaluation bands, associated with different scores and colours as explained above. Each indicator is positioned on the chart and there is no overall unique ranking for regions/HAs. When the result has a high score, it is displayed close to the centre (dark green), and when the score is low, it is displayed far from the centre (red).Figure 3


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)

The ‘dartboard’.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig3: The ‘dartboard’.
Mentions: In order to show the performance of each region or HA, a chart with the six dimensions is used (see Figure 3). The chart is also divided into five evaluation bands, associated with different scores and colours as explained above. Each indicator is positioned on the chart and there is no overall unique ranking for regions/HAs. When the result has a high score, it is displayed close to the centre (dark green), and when the score is low, it is displayed far from the centre (red).Figure 3

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