1,721,021 research outputs found
Digital transformation in healthcare : challenges and opportunities in policy and management
No full textSustaining 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
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
Reshaping the institutional design of primary care: why now and what’s next?
No full textThe growing importance of Primary Care services, understood as those services not provided in
the hospital, is mainly due to the progressive ageing of the population. As a matter of fact, elderly
people are more likely to be affected by chronic diseases, which require a comprehensive
treatment, often involving more than one professional figure and more than one setting.
The average age of Europeans, as well as that of all the people living in developed countries, is in
fact increasing; that is why decision-makers are looking for innovative management tools, like
efficient organisational models or the definition of standard treatment paths for chronic diseases,
encouraging coordination and continuity of health care.
Italy is not an exception.
This study aims to understand how Local Health Authorities (LHAs) in Italy are answering to the
new health needs of the population, particularly from the Primary Care’s point of view. The paper
reports some results of a case study research on the innovative organizational changes of Primary
Care services and tries to systematize: 1) what are the main innovations; 2) how the role of the
General Practitioner (GP) has changed in the new organizational models
Governing through evidence. A study of technological innovation in healthcare.
No full textThe evidence-based paradigm is increasingly permeating the spheres of policymaking and management in healthcare, as it has in most other public domains. An emerging stream of research has investigated how different institutional arrangements are more or less conducive to an effective evidence-based policy. We contribute to this stream through a multiple case design on governing technological innovation. In particular, the study unpacks the dynamics through which policymakers have governed the adoption of the Da Vinci robot within the Italian healthcare system. The analysis leads to the elaboration of four archetypes for governing through evidence, the common mechanisms of which are systematized in an emerging theory. The framework developed here suggests that governing through evidence entails selecting or combining a variety of evidentiary bases, structuring a new relational arrangement among the actors involved and standardizing decisional criteria and procedures. The combination of these elements with the specific governing output sought by policymakers explains the different steering capabilities of institutional arrangements in practice
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
International Pathways to Mental Health System Transformation: Strategies and Challenges
No full textA wide range of funding mechanisms, organizational
structures, political institutions and cultural and professional traditions characterize the mental health service systems of Australia, Canada, England, Italy, New Zealand, Scotland, and the United States. Despite these differences, an analysis of policy documents and reports from these seven countries reveals a striking national-level policy consensus about the need for substantial if not radical change of their respective mental health systems. The congruence of vision, values, and priorities in their reform efforts strongly argues for the importance
of ongoing international dialogue and exchange. This implicit agreement on a change agenda invites opportunities for collaboration in systems design and planning, innovation and implementation, and strategies for change, along with services researc
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