Anna Bonini

Disinvestment for re-allocation: A process to identify priorities in healthcare

Resource scarcity and increasing service demand lead health systems to cope with choices within constrained budgets. The aim of the paper is to describe the study carried out in the Tuscan Health System in Italy on how to set priorities in the disinvestment process for re-allocation. The analysis was based on 2007 data benchmarking of the Tuscan Health System with an impact on the level of resources used. For each indicator, the first step was to estimate the gap between the performance of each Health Authority (HA) and the best performance or the regional average. The second step was to measure this gap in terms of financial value. The results of the analysis demonstrated that, at the regional level, 2-7% of the healthcare budget can be re-allocated if all the institutions achieve the regional average or the best practice. The implications of this study can be useful for policy makers and the HA top management. In the context of resource scarcity, it allows managers to identify the areas where the institutions can achieve a higher level of efficiency without negative effects on quality of care and instead re-allocate resources toward services with more value for patients.

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

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.

Building China's municipal healthcare performance evaluation system: a Tuscan perspective†

Regional healthcare performance evaluation systems can help optimize healthcare resources on regional basis and improve the performance of healthcare services provided. The Tuscany region in Italy is a good example of an institution which meets these requirements. China has yet to build such a system based on international experience. In this paper, based on comparative studies between Tuscany and China, we propose that the managing institutions in Chinas experimental cities can select and commission a third-party agency to, respectively, evaluate the performance of their affiliated hospitals and community health service centers. Following some features of the Tuscan experience, the Chinese municipal healthcare performance evaluation system can be built by focusing on the selection of an appropriate performance evaluation agency, the design of an adequate performance evaluation mechanism and the formulation of a complete set of laws, rules and regulations. When a performance evaluation system at city level is formed, the provincial government can extend the successful experience to other cities.

Gli indicatori per la qualità e la sicurezza delle cure

Ogni processo di miglioramento organizzativo necessita di misure: infatti, cio che si ritiene abbia la rilevanza per essere oggetto di misurazione merita attenzione e permette di focalizzare gli sforzi per ottenere un miglioramento. Le misure, quindi, svolgono un ruolo fondamentale nelle organizzazioni e nei sistemi sociali perche riescono a dare la dimensione, il ritmo e la direzione del cambiamento atteso. L’OMS (1981) definisce gli indicatori come informazioni cruciali e selezionate che aiutano a misurare cambiamenti in relazione a bisogni prioritari e permettono di monitorare specifici aspetti di politica sanitaria o di fattori rilevanti alla determinazione di politiche sanitarie o correlate. Rappresentano, dunque, informazioni utili a misurare le situazioni, i cambiamenti e, conseguentemente, a orientare i processi decisionali nei diversi livelli istituzionali. Gli indicatori possono avere una funzione descrittiva di un contesto o di un fenomeno ma, negli ambiti in cui si definisce un obiettivo a cui tendere in termini numerici, costituiscono uno strumento essenziale per misurare la capacita del sistema di conseguire il risultato atteso.