Mario Del Vecchio

Private health care expenditure and quality in Beveridge systems: Cross-regional differences in the Italian NHS

Private health care expenditure ranges from 15% to 30% of total healthcare spending in OECD countries. The literature suggests that there should be an inverse correlation between quality of public services and private expenditures. The main objective of this study is to explore the association between quality of public healthcare and private expenditures in the Italian Regional Healthcare Systems (RHSs). The institutional framework offered by the Italian NHS allows to investigate on the differences among the regions while controlling for institutional factors. The study uses micro-data from the ISTAT Household Consumption Survey (HCS) and a rich set of regional quality indicators. The results indicate that there is a positive and significant correlation between quality and private spending per capita across regions. The study also points out the strong association between the distribution of private consumption and income. In order to account for the influence of income, the study segmented data in three socio-economic classes and computed cross-regional correlations of RHSs quality and household healthcare expenditure per capita, within each class. No correlation was found between the two variables. These findings are quite surprising and call into question the theory that better quality of public services crowds out private spending, or, at the very least, it undermines the simplistic notions that higher levels of private spending are a direct consequence of poor quality in the public sector. This suggests that policies should avoid to simplistically link private spending with judgements or assessments about the functioning or efficacy of the public system and its organizations.

La psichiatria di fronte alle sfide aziendali

In questo contributo si affronta il tema del rapporto tra la psichia¬tria e i processi di aziendalizzazione. Dopo avere proposto una interpretazione dell’azienda come strumento per il perseguimento di fini unitari attraverso il governo di risorse e attivita interdipendenti, l’articolo sottolinea come nel primo decennio di esistenza del SSN le dinamiche della psichiatria siano state scarsamente influenzate dalla costituzione delle USL. E solo a partire dalla prima meta degli anni ’90 che le mutazioni intervenute nell’ambiente e nel funzionamento interno delle ASL incrociano le dinamiche dei servizi di tutela della salute mentale. La tesi sostenuta e che alcune caratteristiche della psichiatria quali la difficolta a definire un approccio condiviso e a confrontarsi con la misurazione dei risultati ne hanno negativamente condizionato le possibilita di sviluppo in ambito aziendale. Una volta riconosciuta la reale origine delle difficolta, alcuni interventi potrebbero essere messi in campo. L’articolo si chiude con la discussione di alcune possibili tendenze future e dei riflessi di queste sulla psichiatria.