1,721,039 research outputs found
Individual and team performanc: issues around the role of attributes and relationships among peers
Full text linkLa spesa sanitaria: composizione ed evoluzione
Full text linkIl capitolo descrive il livello di finanziamento e la spesa del SS
Unattainable Cost-Efficiency:Interpreting Outsourcing Decisions - The Case of Italian NHS
No full textThe aim of this paper is threefold. First, using the case of hospital inpatient services, we present a framework where the outsourcing option is continuous and divided into the non-mutually exclusive forms of public outsourcing (i.e. contracting-out to a public provider) and private outsourcing (i.e. contracting-out to a private provider). These two options identify a variety of possible configurations of service delivery. In fact, too often outsourcing has been viewed as a dichotomous choice. Instead, we provide evidence that it can be continuous and bi-dimensional (increasing or decreasing outsourcing / increasing or decreasing the presence of private providers). Second, we argue that both public and private outsourcing have similar curvilinear independent effects on cost-containment (with different magnitude of the quadratic terms) but mixing the two (intermediate configurations) is costly. Third, we justify the observed existence and persistence of mixed configurations. The latter form is more costly but we justify its presence among public service organizations because of the specificity of the sector (e.g., institutional and political scrutiny) and its historical traditions coupled with change-associated costs and smooth deviations from a status-quo, and ambiguous perceived effectiveness of different outsourcing decisions. As a consequence, public and private outsourcing in principle could appear as effective strategies for improving costs-containment but reality constraints hinder such efficient configurations which remain de facto unattainable
Cost-minimization analysis to support the HTA of Radiofrequency Echographic Multi Spectrometry (REMS) in the diagnosis of osteoporosis
Full text linkThis study aims at evaluating the costs of REMS vs. the conventional ionizing technology (dual-energy X-ray absorptiometry, DXA) for the diagnosis of osteoporosis from the perspective of the Italian National Health Service (NHS) using a cost-minimization analysis (CMA)
Multi-professional primary care units: what affects the clinical performance of Italian general practitioners?
No full textMulti-professional primary care models promise to deliver better care and reduce waste. This study evaluates the impact of such a model, the primary care unit (PCU), on three outcomes.
A multilevel analysis within a “pre- and post-PCU” study design and a cross-sectional analysis were conducted on 215 PCUs located in the Emilia-Romagna Region in Italy. Seven
dimensions captured a set of processes and services characterizing a well-functioning PCU,or its degree of vitality. The impact of each dimension on outcomes was evaluated. The analyses show that certain dimensions of PCU vitality (i.e. the possibility for GPs to meet and share patients) can lead to better outcomes. However, dimensions related to the interaction
and the joint work of GPs with other professionals tend not to have a significant or positive impact. This suggests that more effort needs to be invested to realize all the potential benefits of the PCU’s multi-professional approach to care
The impact of generic reference pricing in Italy, a decade on
No full textObjectives: The Generic Reference Price (GRP) was introduced in Italy in 2001. The main purpose of this paper is: (a) produce evidence regarding the effect of GRP on prices; (b) test the hypothesis that there is a reallocation of demand from the genericated (and reference-priced) molecules to patent-protected products that have the same therapeutic indication.
Methods: The analysis used a unique dataset of quantities and revenues of six therapeutic groups that were observed for more than a decade. Difference-in-Differences analysis is applied.
Results: On average, prices dropped 13% more in groups to which GRP was applied than in other groups. Moreover, each entry was associated with a price drop of around 2.8%. On the other hand, GRP did not induce any significant switching towards in-patent molecules.
Conclusions: Results provide the first empirical results of the impact of GRP on prices in Italy and evidence that GRP cannot be held solely responsible for the often reported demand reallocation towards new and in-patent molecules
When peers count: the effects on integrated type II diabetes care of communication within general practitioner-only subgroups in interprofessional primary care teams
No full textBackground. Primary care teams (hereafter referred to as primary care units, PCUs) composed of general practitioners (GPs), nurses and specialist doctors have recently been established in the Italian context, with the main aim of improving integrated care for chronic diseases. Purposes. To assess whether the increased professional diversity of PCUs has resulted in an improvement in the integrated care of type II diabetes and to identify a potential mechanism mediating this effect. Methodology/Approach. We analyzed 213 PCUs, comparing their performance in integrated type II diabetes care at two time points. Using social categorization theory and a fixed effects regression analysis, we tested a mediation model in which the frequency of communication among GPs in the PCUs, i.e., within-subgroup communication, mediates the relationship between PCU professional diversity and team performance in diabetes care. Findings. We show that when the professional diversity of the PCUs increases, integrated care of type II diabetes improves and better meets the standards of optimal care. Within-GP subgroup communication works as a mediating mechanism that translates the PCU professional diversity into better team performance. The mediation effect, however, is curvilinear. Beyond certain levels, within-subgroup communication can hamper PCUs’ capacity to work collaboratively in integrated type II diabetes care. Practice Implications. The paper suggests that when creating interprofessional primary care teams, managers might be able to steer teams towards a better performance by encouraging communication among peers of the same profession
The impact of generic reference pricing in Italy, a decade on
No full textObjectives: The Generic Reference Price (GRP) was introduced in Italy in 2001. The main purpose of this paper is: (a) produce evidence regarding the effect of GRP on prices; (b) test the hypothesis that there is a reallocation of demand from the genericated (and reference-priced) molecules to patent-protected products that have the same therapeutic indication.
Methods: The analysis used a unique dataset of quantities and revenues of six therapeutic groups that were observed for more than a decade. Difference-in-Differences analysis is applied.
Results: On average, prices dropped 13% more in groups to which GRP was applied than in other groups. Moreover, each entry was associated with a price drop of around 2.8%. On the other hand, GRP did not induce any significant switching towards in-patent molecules.
Conclusions: Results provide the first empirical results of the impact of GRP on prices in Italy and evidence that GRP cannot be held solely responsible for the often reported demand reallocation towards new and in-patent molecules
Il settore dei dispositivi medici in Italia. L’impatto delle politiche pubbliche sulle performance delle imprese
No full textThe Italian medical device industry experiences a strong regulatory influence due to the predominant presence of public purchasers. During the last decade, regional governments have introduced a wide range of policies to control public expenditure and particular attention has been paid to public purchasing procedures. This study aims at analyzing the impact of the new public procurement policies on wholesalers’ performance (ROE, current ratio, collection period) starting from the analysis of two different cases: disposable devices and dental devices. Our results show that the adoption of a centralized purchasing strategy produces a decrease in wholesalers’ ROE in the short run, but this effect appears to be less evident (although still significant) in the Regions where this model has been established earlier and is more frequently adopte
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