Paola Adinolfi

The Italian Health Literacy Project: Insights from the assessment of health literacy skills in Italy

Inadequate health literacy, namely the problematic individuals ability to navigate the health care system, has been depicted as a silent epidemic affecting a large part of the world population. Inadequate health literacy has been variously found to be a predictor of patient disengagement, inappropriateness of care, increased health care costs, and higher mortality rates. However, to date the evidence on the prevalence of limited health literacy is heterogeneous; moreover, studies dealing with this topic show a pronounced geographical concentration. To contribute in filling these gaps, this paper investigates health literacy skills in Italy. Drawing on the European Health Literacy Survey (HLS-EU), a tool to measure self-perceived levels of health literacy was administered to a representative sample of Italian citizens. A stepwise regression analysis allowed to shed light on the determinants and consequences of limited health literacy. Findings suggested that inadequate health literacy is a prevailing problem in Italy, even though it has been overlooked by both policy makers and health care practitioners. Financial deprivation was found to be a significant predictor of inadequate health literacy. Low health literate patients reported higher hospitalization rates and greater use of health services. As compared with the European Countries, Italy showed some peculiarities in terms of health literacy levels and socio-demographic determinants of health literacy, which provide with intriguing insights for policy making.

Barriers to Reforming Healthcare: The Italian Case

Using the conceptual lenses offered by the ideational and cultural path taken in the health care arena, this article attempts to explain the trajectory of recent major health care reforms in Italy and the reasons for their failure, as well as providing some directions for successful intervention. A diachronic analysis of the relatively under-investigated phenomenon of health care reforms in Italy is carried out, drawing on a systematic review of the Italian and international literature combined with the research work carried out by the Author. For all the three major health reforms examined, a significant gap between the authoritative policy choices taken and the overall implementation, in terms of process and system changes, can be observed, determining a growing distance between the theoretical efficiency and the practical effectiveness of the Italian National Health Service (NHS) as well as its detachment from the social system. The main obstacle to effective reform seems to be the cultural hegemony of the administrative-managerial and the biomedical paradigms, which, by reinforcing one another, yielded infertile ground for renewing in a post-modern sense the Italian NHS. The various Reforms have not been conceived to break such a positivistic monopoly in that they did not promote cultural or educational intervention. In this context, intervention that acts at a cultural level, such as reforming university education for physicians and managers or devising immigration policies to attract adequately acculturated people to the Italian NHS, seems to be the most promising.

Philosophy, Medicine and Healthcare: Insights from the Italian Experience

To contribute to our understanding of the relationship between philosophical ideas and medical and healthcare models. A diachronic analysis is put in place in order to evaluate, from an innovative perspective, the influence over the centuries on medical and healthcare models of two philosophical concepts, particularly relevant for health: how Man perceives his identity and how he relates to Nature. Five epochs are identified—the Archaic Age, Classical Antiquity, the Middle Ages, the Modern Age, the ‘Postmodern’ Era—which can be seen, à la Foucault, as ‘fragments between philosophical fractures’. From a historical background perspective, up to the early 1900s progress in medical and healthcare models has moved on a par with the evolution of philosophical debate. Following the Second World War, the Health Service started a series of reforms, provoked by anti-positivistic philosophical transformations. The three main reforms carried out however failed and the medical establishment remained anchored to a mechanical, reductionist approach, perfectly in line with the bureaucratic stance of the administrators. In this context, future scenarios are delineated and an anthropo-ecological model is proposed to re-align philosophy, medicine and health care.

Health Outcomes and Patient Empowerment The Case of Health Budgets in Italy

Scholars claim that the outcomes of health interventions are the products of three factors: the size, the penetration and the sustainability of their effects. Nonetheless, the prevailing biomedical ethic of care engenders a mere ‘fix-it’ approach, which focuses on the clinical treatment of the disease and neglects the role of patients in the process of care. This approach undermines both the size and the penetration of health interventions. From this standpoint, the authors examine different health interventions aimed at improving the size and the penetration of their effects through the empowerment of the patients and their involvement in the provision of care. They are confronted in terms of two different criteria: the ‘intensity’ of the health care co-production and the ‘breadth’ of the health-related needs contemplated. Besides, their outcomes—in terms of health status improvement, patients’ satisfaction and cost savings—have been contrasted. A detailed case study dealing with a pilot project launched in Italy, which involved full-fledged empowerment of the patient, is presented. It is compared with similar initiatives carried out in other European and non-European countries, with the purpose of stressing the peculiarities of the former and explaining the reasons for its success. The findings of this study support the exploratory hypothesis that the higher the intensity of co-production and the wider the breadth of health-related needs considered, the better the outcomes of health interventions.

Sentiment Analysis to Evaluate Teaching Performance

The aim of this work is to review a specific learning analytics method-sentiment analysis-in the field of Higher Education, showing how it is employed to monitor student satisfaction on different platforms, and to propose an architecture of Sentiment Analysis for Higher Education purposes, which trace and unify what emerges from the literature review. First, a literature review is carried out, which proves the widespread and increasing interest of the communities, of both scholars and practitioners, in the use of sentiment analysis in the field of Higher Education. The analysis, focused on three different e-learning domains, identifies weaknesses and gaps, and in particular the lack of a unifying approach which is able to deal with the different domains. Secondly, a prototype architecture-LADEL Learning Analytics Dashboard for E-Learning-is introduced, which is able to deal with the different e-learning domains. Some preliminary experiments are carried out, highlighting some limitations and open issues, as stimulus to continue the development of the platform.

The Italian Electronic Public Administration Market Place: Small Firm Participation and Satisfaction

The paper reconstructs the path taken by the reform of public procurement in Italy which has gradually evolved from a and centralized market to an open and accessible one. Despite the development of the Electronic Public Administration Market Place (MEPA), information regarding its performance is scant. There are no available collected data on firm satisfaction. The paper discusses the role Consip, a public company owned by the Ministry of Economy and Finance, has played (and continues to play) to guide the decentralization of public e-procurement. At the same time it shows the results of a sample investigation aimed at analysing the level of satisfaction of small/medium enterprises (SMEs) participating in the MEPA.

Myth #7: The Myth of Measurement

The mantra that inspires healthcare systems is: “If you can’t measure it, you can’t manage it.” The measuring process is closely related to the epistemological ideal of modern science. This has been developed through a world simplification, which is considered useful to disclose principles that work under surrounding reality. The search for natural laws carries a distinctive component: phenomena are not accepted as they are, but they are instead transformed through abstraction and experimentation. What is considered as real is the result of abstraction and experimentation. This attitude, however, entails that some reality aspects are sacrificed in their variety and entirety. In economics, especially in the rational choice theory, the world, where we make decisions and judgments, is not real, but outward and accidental. In its stead, we find abstract constructions of expected utility maximization and pursuit of self-interest.

Looking Through the Lens of the Complexity Paradigm

The contributions in this volume have offered separate insights and frameworks and, around these, a mosaic of specific indications and applications which remain irreducibly various. There are indeed some common points, which deserve to be highlighted.

A Plural Analysis of Health Myths: Overview of the Volume

In this chapter we present an overview of the contributions received from academics and practitioners invited to comment on Henry Mintzberg’s myths. The chapter is organized around nine paragraphs: each of them corresponds to one of the myths, according to the original Henry Mintzberg’s sequence; the last paragraph deals with Gummesson’s reflections and related comments.

The Historical Evolution of Health Concepts and Approaches: The Challenge of Complexity

An adage says that “myth is more potent than history” (Fulghum 1988, p. vii). Indeed, the myths of health care identified by Henry Mintzberg (2012) have proven to be stronger than both history and reality. They have played and still play a significant role in affecting health policies and practices, influencing the shapes of health care systems. The belief that the health care system is failing, the assumption that it could be fixed by detached social engineering and heroic leadership, the idea that public health care guarantees equality while private health care ensures efficiency, the blind trust in the healing role of management models drawn on the for-profit sector, the emphasis on scale and measurement, all these are common prescriptions to cure the illness of current health care systems.