Giovanna Vicarelli

Italy: A Strange NHS with Its Paradoxes

In the last 20 years the Italian National Health Care System (NHS) has experienced a significant process of transformation. The NHS was introduced in 1978 substituting a previous Social Health Care Insurance model (Vicarelli, 2011). While the 1980s represented a decade when governments tried to implement the new institutional design for health care, the 1990s were already a time of discernible change: at the beginning of the decade, for a series of reasons that will be explained later in this chapter, attempts were made to dismiss the NHS and shift to a more private-like system. These attempts failed but important transformations took place nevertheless (Vicarelli, 2011).

Dynamics between doctors and managers in the Italian National Health Care System

This article focuses on the changes in the Italian NHS by concentrating on patterns in the managerialisation of doctors. It addresses a series of shortcomings in studies on the response by doctors to managerialisation. The first is a shortcoming of theoretical and analytical nature. It is necessary to adopt a broader perspective whereby analysis considers not only the interaction between doctors and managers, but also the public control and regulation agencies that operate in that field. The second shortcoming is a methodological one. The literature on managerialisation is more theoretical than applied. It is necessary to adopt a strategy based on a plurality of methodologies and sources in order to focus attention on a national case (Italy in the present study), discussing the changes over time (from the beginning of managerialisation until today) and considering different groups within the medical profession. The outcome is a complex picture of the dynamics between doctors and managers which foregrounds the managerial co-optation processes of a small group of national health service doctors, the transition from strategic adaptation to forms of resistance against managerialisation by the majority of Italian NHS doctors, and the emergence of restratification processes among self-employed doctors working with the NHS.

Stress, burnout e insoddisfazione dei medici: un campo di indagine aperto

Despite the triumph of medicine, as concerns the cures and the well-being ensured to the population, the dissatisfaction of both actors of the therapeutic relationship has grown over the past decades. Both patients and doctors seem to be disoriented in front of the great challenges that are taking place. The rapid change we are now witnessing seems to create a situation of anomie (which is reflected on the experience of health care workers) that is difficult to manage in a period of economic and political crisis as well as of great discoveries in science and technology. The paper focuses on the unease of doctors: starting from the analysis of the international literature it will try to identify some possible streams of research on a phenomenon that still appears insufficiently examined in Italy, despite the wide concern both at the individual level and at the collective one.

Le domande dei cittadini e le responsabilità dei medici. Verso un nuovo contratto sociale tra medici e welfare in Europa

Differently from the United States, where market competition, individual responsibility, technological progress, and consumerism are still the dominant values in a health care system considered as a ‘market’ just as any other economic market, in Europe the debate on health care reforms involves various stakeholders such as politicians, managers, physicians and citizens. Particularly, the focus here is on physicians’ different levels of accountability in the rationing process and priorities selection, in order to redefine the ‘social contract’ among physicians and the State in new terms within the current welfare systems.

Il genere nelle professioni di cura. La diade medico-infermiere

In Italy, even if men have always been employed in nursing care and we have witnessed female doctors since the beginning of 20th century, health care services are shaped along the professional dominance of male-doctors upon femalenurses. Yet, at the end of the nineties the situation changed. By now, almost half of the doctors are women while about a fifth (21% - February 2001) of nurses are men. Such a situation, according to Giovanna Vicarelli, deserves a set of reflections in order to understand its consequences on professional identities and on the organization of health care services

Fiducia e stima nei riguardi della professione medica in Italia. Un'interpretazione di carattere storico-comparativo

In Italy many people seem to distrust physicians. In order to understand this attitude it is necessary to turn to the branch of sociology that deals with the professions as well as to the studies on the systems of welfare. These instruments support the teory that both professional legitimacy and trust have been, in Italy more than in other countries, the result of individual and community relatantionships rather than of institutional instruments of social and scientific recognition. These are the fragile foundations on which a phisician-client relationship of the patron-client type has been built. This relationship was justified as long as italian society was characterised by very little state and market regulation, but when things changed, physicians were unable to find, inside the profession, the instruments necessary to renew the health pact, and chose the path of political or economic dominance. This is what people blame them for now.