Elio Borgonovi

Sustaining Universal Health Coverage: The Interaction of Social, Political, and Economic Sustainability

The sustainability of health care systems, particularly those supporting universal health care, is a matter of current discussion among policymakers and scholars. In this article, we summarize the controversies around the economic sustainability of health care. We attempt to extend the debate by including a more comprehensive conceptualization of sustainability in relation to health care systems and by examining the dimensions of social and political sustainability. In conclusion, we argue that policymakers when taking decisions around universal health care should carefully consider issues of social, political, and economic sustainability, their interaction, and often their inherent trade-offs.

The cost-effectiveness of the Argus II retinal prosthesis in Retinitis Pigmentosa patients.

BackgroundRetinitis Pigmentosa (RP) is a hereditary genetic disease causing bilateral retinal degeneration. RP is a leading cause of blindness resulting in incurable visual impairment and drastic reduction in the Quality of life of the patients. Second Sight Medical Products Inc. developed Argus II, a retinal prosthesis system for treating RP. Argus II is the world’s first ever-commercial implant intended to restore some vision in the blind patients. The objective of this study was to assess the cost-effectiveness of the Argus® II Retinal Prosthesis System (Argus II) in Retinitis Pigmentosa (RP) patients.MethodA multi -state transition Markov model was developed to determine the cost-effectiveness of Argus II versus usual care in RP from the perspective of healthcare payer. A hypothetical cohort of 1000 RP patients aged 46 years followed up over a (lifetime) 25-year time horizon. Health outcomes were expressed as quality adjusted life years (QALYs) and direct healthcare costs expressed in 2012 €. Results are reported as incremental cost per ratios (ICERs) with outcomes and costs discounted at an annual rate of 3.5%.ResultsThe ICER for Argus II was €14,603/QALY. Taking into account the uncertainty in model inputs the ICER was €14,482/QALY in the probabilistic analysis. In the scenarios of an assumption of no reduction on cost across model visual acuity states or a model time horizon as short as 10 years the ICER increased to €31,890/QALY and €49,769/QALY respectively.ConclusionThis economic evaluation shows that Argus II is a cost-effective intervention compared to usual care of the RP patients. The lifetime analysis ICER for Argus II falls below the published societal willingness to pay of EuroZone countries.

Examining the antecedents of engaged nurses in Italy: perceived organisational support (POS); satisfaction with training and development; discretionary power.

AIMnThis paper used Social Exchange Theory to empirically examine whether perceived organisational support, satisfaction with training and development and perception of discretionary power are antecedents of engagement for registered nurses working in Italian public and private hospitals (nxa0=xa0827).nnnBACKGROUNDnAccording to Social Exchange Theory, effective workplace relationships support employees and encourage nurses to use training to enhance their workplace outcomes.nnnMETHODnThis research used a cross-sectional design. Data were collected from registered nurses working in six Italian hospitals using a survey-based, self-report strategy.nnnRESULTnRegression analysis found that the variance of process-oriented supervision accounted for 6.9% of Italian registered nurses perception of engagement, training and development accounted for 26.8% and discretionary power accounted for 2.1%.nnnCONCLUSIONnWorkplace relationships enhance autonomy and engagement. Effective workplace relationship impacts positively on nurses outcome.nnnIMPLICATIONS FOR NURSING MANAGEMENTnThis paper confirms the relevance of training to enhance engagement of nurses. It also confirms the importance of workplace relationships in enhancing autonomy and engagement. Previous research has identified the importance of nurses autonomy in an environment where there are shortages of nurses. This study confirms a similar situation for Italian nurses. The findings underline the relevance of investments in continuous professional development to enhance nurses engagement in private and public health-care settings.

Accounting and accountability in local government: a framework

Jones and Pendlebury (1992) have emphasised that “accounting is a purposive activity”, i.e. it is “directed towards a specified end” and “must above all be useful”. Luder (1992) has shown that the existing cross-country variations in government accounting models stem from environmental pressures and from the needs of external and internal users. This paper focuses on the relationship between the goals assigned to local government (LG) accounting systems over time and their technical features, and aims at identifying the main methodological issues concerning such relationship.

Outcome-based performance management in the public sector

Moving to outcome-based measurement systems in the public sector has been difficult. In this article, we examine the contingent decision-making arguments stimulating output instead of outcome measurement in public management. Based on an argumentative literature review, we conclude that there exist several contingent arguments encouraging politicians and public managers to stick with outputs while ignoring outcomes in performance measurement. Mapping out these arguments contributes to understanding the difficulties in implementation of outcome-based measurement and management systems. This understanding is highly useful in performance management research and policy practice. We also suggest that these contingent arguments may be considered proposals for the future research in the area of public financial management and public sector performance measurement.

Leader-member exchange, affective commitment, engagement, wellbeing, and intention to leave: public versus private sector Italian nurses

In the context of nurse shortages and budget constraints in hospitals, retaining skilled nurses is crucial. This paper investigates the impact of supervisor–nurse relationships on engagement, wellbeing, affective commitment and turnover intention for Italian private and public sector nurses. Private sector nurses in Italy were found to be more committed, engaged and had higher perceptions of wellbeing than public sector nurses. Based on these results, public managers need to do more to sustain the motivation of nurses in public sector hospitals.

Public Authorities for Entrepreneurship: A management approach to execute competitiveness policies

Abstract Decentralization, globalization and European Union cohesion and competitiveness agendas have shifted the focus of development policies from the central to the regional and local levels. Most studies on economic development are informed by macroeconomic and entrepreneurial theories, the normative implications of which are unclear for public authorities attempting to enhance competitiveness and entrepreneurship in their communities. This paper discusses the centrality of implementation efforts for the effectiveness of regional and local competitiveness programmes and policies. Striving to capture the challenges posed by the international literature, the paper presents a managerial approach, developed under an inductive–deductive method grounded in some Italian cases of entrepreneurial development. The intention is to provide a reference point for regional and local public managers whose task it is to select and execute actions and instruments to support businesses start up and growth.

G8 Summit 2009: what approach will Italy take to health?

In the past decade, the G8 played an important part in the establishment or support of global health initiatives that are at risk today of becoming part of the problem rather than the solution for granting health coverage to disadvantaged populations. The fragmentation of fi nancing for global health and increased transaction costs contrast with the need for effi cient and eff ective health systems, and underline the need for a review of quick-fi x and selective approaches. In view of the present economic crisis, a heightened commitment from wealthy countries to sustain global health will be needed. As chair of the G8 Summit 2009, Italy will have a unique opportunity to renew its commitment to global health and orient action towards a more eff ective approach. Italy’s Offi cial Development Assistance continues to suff er from structural weaknesses, characterised by an absence of clear political direction, weak management, and inadequate and unstable funding. The health sector has been no exception. Nevertheless, two aspects deserve to be noted. First, as the result of contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria, launched at the Genoa G8 Summit in 2001, the donations of Italian Offi cial Development Assistance for Health tripled between 2001 and 2007 (Italy is the fourth largest contributor to the Global Fund along with Japan, after France, the USA, and the UK). Italy also engaged in new fi nancing mechanisms, including the International Financial Facility for Immunisation and the Advance Market Commitment for vaccines initiatives, by pledging substantial funds. Arguably, this shift towards vertical initiatives has not been accompanied by attempts to address concerns about potential consequences for global health governance and the negative system-wide eff ects at a country level. The shift also contrasts with the longstanding guiding principles of the Italian Development Cooperation in the health sector—characterised by a comprehensive rather than a selective approach to health—and also with the domestic experience of the Italian National Health Service that provides universal and comprehensive care. Second, Italy’s contribution to global health already goes beyond traditional Offi cial Development Assistance. The Italian National Health Service and the decentra lised public institutions (regions and municipalities) are increasingly engaged in development cooperation. Civil society is very active (in Italy, 1433 not-for-profi t organisations are associated with international cooperation and solidarity activities, has produced a study that in every respect rivals those in diseases for which research receives vastly superior funds.

Imprenditorialità, consenso sociale e sviluppo dell’impresa

L’economia e l’insieme delle attivita finalizzate a soddisfare i bisogni tramite la produzione, il trasferimento, il consumo di beni dotati di utilita. L’impresa e l’istituzione della societa moderna che consente di aumentare le capacita di rispondere a bisogni sempre piu numerosi e di qualita piu elevata in relazione alla capacita di anticipare le esigenze future, di assumere il rischio connesso all’incertezza, di gestire la complessita organizzativa e di aumentare la produttivita. Nell’impresa, tuttavia, la razionalita economica e applicata con modalita diverse che hanno avuto un’evoluzione nel tempo. In particolare, dalla concezione di impresa considerata “meccanismo di trasformazione economica” distinta e a volte separata dal contesto sociale, si e passati ad una concezione di impresa che e parte integrante del contesto istituzionale e sociale in cui opera. Essa non ha solo l’obiettivo di aumentare quantitativamente la ricchezza economica, ma quello piu ampio di generare ricchezza in quantita e qualita idonee a creare consenso da parte di molteplici soggetti (sviluppo sostenibile). Key words: imprenditorialita, competizione, collaborazione, progresso sociale

Public–Private Sector Comparisons of Nurses’ Work Harassment Using Set: Italy and Australia

Abstract Using Social Exchange Theory, this study compared the impact of nurses’ workplace relationships with management and colleagues upon nurses’ work harassment, psychological well-being, and engagement within the public and private sectors in both Australia and Italy. Using survey data from 1,587 nurses, SEM findings indicated that public sector nurses in Australia had the lowest satisfaction with supervision, higher work harassment, and lower engagement and psychological well-being, than the other groups. The implications include that poor workplace relationships enable work harassment and therefore management upskilling is required along with changes in performance measures to ensure greater nurse well-being and engagement.