Elena Cantu

Phasing Out Market Mechanisms in the Italian National Health Service

The Italian National Health Service introduced quad-markets, regionalization, and managerialism in the 1990s. Under quasi-markets, large providers have been separated from purchasers and funded by ‘activity’—the quantity, mix, and possibly appropriateness of services provided. Under regionalization, each of Italys 21 regional governments is able to design its own funding arrangements. The regions have generally been trying to mitigate the effects of quasi-markets and are now increasingly ‘governing’ them. The system is producing some desirable results, including a shift from ordinary to same-day hospitalizations and a reduction in length of stay. Hospital admissions increased initially, but only where the regions encouraged this. Financial effects are more controversial.

Multiple logics and accounting mutations in the Italian National Health Service

Abstract Traditional public administration (PA) relied on cash- or commitment-based budgets, while NPM advocated accruals accounting. Currently, Continental Europe is witnessing the re-emergence of the PA logic, but the relevant accounting implications have been insufficiently investigated. We focus on the Italian National Health Service. Our findings suggest that accruals accounting will not be repealed. However, accounting mutations will be introduced to increase consistency with the PA logic and budgetary accounting. Accruals accounting numbers will be interpreted and used accordingly. Great attention will be paid to nation-wide consolidated statements for the control of public finances, while faithful representation of individual organisations will be overshadowed.