104 research outputs found
Implementing performance-based funding for health research: when governance and procedural fairness matter
No full textThe article examines the implementation by the Italian Ministry of Health of performance-based funding to allocate resources for research to IRCCS (Istituti di Ricovero e Cura a Carattere Scientifico) hospitals. The analysis provides evidence that ten years from its introduction the performance-based funding system has persisted, but it has been implemented rather differently from what had been imagined by its proponents. By drawing on the theoretical frameworks of policy implementation,
agency, and relational contracting, the study establishes that the overall design of the system has contributed to this final outcome only to a limited extent. Rather, the lack of procedural fairness, as
well as of political leadership in linking the system to national research priorities, has undermined the basis for trust between hospitals and the Ministry of Health. The article discusses how, in
this, the governance of performance-based funding and its strong ownership by the ministerial bureaucracy has been determinant
Digital transformation in healthcare : challenges and opportunities in policy and management
No full textExplaining the unexpected success of the smoking ban in Italy: Political strategy and transition to practice, 2000-2005
No full textThe approval (2003) and enforcement (2005) of a smoking ban in Italy have been viewed by many as an unexpectedly successful example of policy change. The present paper, by applying a processualist approach, concentrates on two policy cycles between 2000 and 2005. These had opposing outcomes: an incomplete decisional stage and an authoritative decision, enforced two years later. Through the analysis of the different phases of agenda setting, alternative specification and decision making, we have compared the quality of participation of policy entrepreneurs in the two cycles, their political strategies and, in these, the relevance of issue image. The case allows us to direct the attention of scholars and practitioners to an early phase of the policy implementation process - which we have named 'transition to practice'. This, managed with political strategy, might have strongly contributed to the final successful policy outcome. © 2010 Blackwell Publishing Ltd
Sustaining Universal Health Coverage: The Interaction of Social, Political, and Economic Sustainability
No full textAbstractThe 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
Analisi del sistema di finanziamento della ricerca sanitaria in Italia
No full textAnalisi dei modelli di finanziamento della ricerca sanitaria; focus sulla ricerca finanziata dal Ministreo della Salute e ruolo degli ospedali IRCCS; comparazione intrenazionale con Germania, Francia e Inghilterr
Life beyond emergence: institutional intermediaries and the persistence of hybrid forms
No full textWe report on a multi-level longitudinal study investigating a population of public-private hybrid organizations in the Italian healthcare field, where a public service and quasi-market logic coexist. A combination of survey, interviews and archival data allowed us to trace the dynamics of persistence and decay of two hybrid templates over 25 years (1992-2016). By bridging the literature on institutional complexity and hybrids with insights from imprinting, we illuminate the role of field-level actors (regional authorities) who as institutional intermediaries and agents of recursive imprinting embed their prioritization of institutional logics in distinct templates for organizing, and provide them to hybrid organizations during multiple sensitive periods over time. Our findings draw attention to the differential institutional capacity of institutional intermediaries to prioritize and enforce institutional logics, and to the diverse relational, procedural and discursive mechanisms they employ during imprinting processes. Ultimately, our findings advance the understanding of how certain hybrid forms come to persist while others decay
The interplay between policy guidelines and localdynamics in shaping the scope of networks: theexperience of the Italian Departments of MentalHealth
No full textIn the mental health field, the creation of networks that can guarantee the smooth coordination of
services and organizations across sectors is a priority in the policy agenda of several countries. In Italy,
Departments of Mental Health (DMHs) have been designated responsible for the system of specialist
mental health services, and also mandated as the conveners and leaders of interorganizational and
cross-sectoral networks, by a system-wide reform. This study aims to understand how mental health
networks have been assembled in this context and the factors and motivations that have shaped their
scope. By combining an analysis of policies with a survey of DMH directors, we have determined that
DMHs have preferentially formed collaborative relationships with social service providers (local governments)
and the voluntary sector. In contrast, relationships with substance abuse and addiction services
and primary care providers were weak and stifled by a lack of trust and by conflict about respective
contributions to mental care. We explore the reasons for this selectivity in interorganizational relationships
and propose that a lack of targeted incentives in policy guidelines, on the one hand, and the existence of
a mandated network leadership, on the other, have led to a rather narrow range of collaborations
Genetic Screening for the Predisposition to Venous Thromboembolism: A Cost-Utility Analysis of Clinical Practice in the Italian Health Care System
No full textAbstractObjectivesIn the Italian health care system, genetic tests for factor V Leiden and factor II are routinely prescribed to assess the predisposition to venous thromboembolism (VTE) of women who request oral contraception. With specific reference to two subpopulations of women already at risk (i.e., familial history or previous event of VTE), the study aimed to assess whether current screening practices in Italy are cost-effective.MethodsTwo decisional models accrued costs and quality-adjusted life-years (QALY) annually from the perspective of the National Health Service. The two models were derived from a decision analysis exercise concerning testing practices and consequent prescribing behavior for oral contraception conducted with 250 Italian gynecologists. Health care costs were compiled on the basis of 10-year hospital discharge records and the activities of a thrombosis center. Whenever possible, input data were based on the Italian context; otherwise, the data were taken from the international literature.ResultsCurrent testing practices on women with a familial history of VTE generate an incremental cost-effectiveness ratio of €72,412/QALY, which is well above the acceptable threshold of cost-effectiveness of €40,000 to €50,000/QALY. In the case of women with a previous event of VTE, the most frequently used testing strategy is cost-ineffective and leads to an overall loss of QALY.ConclusionsThis study represents the first attempt to conduct a cost-utility analysis of genetic screening practices for the predisposition to VTE in the Italian setting. The results indicate that there is an urgent need to better monitor the indications for which tests for factor V Leiden and factor II are prescribed
Systematic review of the economic literature on genetic testing for the prevention of venous thromboembolism
No full textNo abstract availabl
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