1,721,039 research outputs found
How the health services of Emilia-Romagna, Lombardy and Veneto handled the Covid-19 emergency
Full text linkThe article analyses how the regional health serevices of Emilia-Romagna, Lombardy and Veneto handled the Coronavirus emergency in the initial months of 2020. For each region, it is identified who was in charge, what role was attributed to experts, what emergency structures were set up.
Particular attention is paid to the ways in which the regions interacted with the national government, the ability to frame the problem, the promptness with which certain policy measures were adopted, the ability to use the knowledge at their disposal.
Lombardy is charged with a series of errors, largely due to having passively followed some directives issued by the national government. Veneto, going against some national indications, showed readiness in making decisions and bricolage skills. Emilia-Romagna, after an initial hesitation, showed the ability to reorganize itself, and to learn from mistakes
L'universalismo sanitario sulla carta e nella realtà
Full text linkL’articolo intende investigare – prima in chiave comparata e poi soffermandosi sul caso italiano – il tema della copertura sanitaria universale. Tale concetto viene “spacchettato” in due diverse componenti, quella della diffusione dell’assicurazione sanitaria e quella della generosità del pacchetto assicurativo.
La prima parte dell’articolo consiste nell’analisi comparata della diffusione dell’assicurazione sanitaria nei paesi OCSE e in quelli dell’Unione Europea: si vedrà come negli ultimi 40 anni i paesi capaci di garantire la copertura dell’intera popolazione siano andati progressivamente aumentando.
Oltre alla diffusione della copertura assicurativa viene considerata anche la generosità degli schemi assicurativi adottati nei diversi paesi. Verranno a tal fine utilizzati due indicatori: la spesa sanitaria out-of-pocket e gli “unmet medical needs”. Tra i paesi europei che – sulla base degli indicatori utilizzati – possono essere catalogati come “universali ma poco generosi” ricade anche l’Italia.
La seconda parte dell’articolo si sofferma perciò sul caso italiano, italiano: si valuterà in quale misura il SSN italiano sia davvero universale, individuando i principali fattori che limitano l’accesso alle cure
Classification of healthcare systems: Can we go further?
Full text linkThis article addresses the issue of the classification of healthcare systems, with the intent to take a step further than the previously analysed models of healthcare organisation. As concerns the financing of healthcare services, the standard tripartite classification (according to which healthcare systems are divided into three groups: voluntary insurance, social health insurance and universal coverage) is enriched with two additional types: compulsory national health insurance and residual programs. With respect to the provision of services and the relationship between insurers and providers, it is important to distinguish between vertically integrated and separated systems. What differentiates this analysis from the majority of previous studies is its underlying logic. Assuming that all systems are hybrid, the article proposes to put aside the classic logic for classifying healthcare systems (according to which individual countries are pigeonholed into different classes depending on the prevailing system) in favour of the identikit logic. The concept of segmentation (of healthcare services or population) proves to be remarkably useful to this purpose
Non solo Bismarck contro Beveridge: sette modelli di sistema sanitario
Full text linkThe article describes 7 different models for financing and delivering health care: 1)
direct market; 2) voluntary private insurance; 3) social health insurance; 4) residual
programs; 5) compulsory national health insurance; 6) universal single-payer system;
7) national health service. The seven models are presented and compared with reference
to the following dimensions: who pays for and who benefits from the system;
the number of insurers, and the public or private nature of the coverage scheme; the
contribution method; users’ freedom of choice; the arrangements between insurers
and providers; the role of the State. The typology is applied to 24 OECD countries
"Obamacare" tra obiettivi e risultati
No full textL'articolo traccia un primo bilancio della riforma sanitaria di Obama.
L’effetto certamente più rilevante della riforma riguarda la diminuzione del numero di americani privi di assicurazione sanitaria. Nel 2010, anno in cui è stata approvata la riforma, gli uninsured negli Stati Uniti erano 48,6 milioni (corrispondenti al 16% della popolazione). Alla fine del 2015 si è arrivati a quota 28,6 milioni di uninsured (9,1% della popolazione). Si deve insomma concludere che per quanto riguarda il problema della copertura assicurativa, la riforma Obama sta decisamente funzionando.
La riforma aveva un secondo obiettivo, quello di ridurre il costo delle polizze sanitarie. Sotto questo aspetto, gli effetti della riforma Obama sono poco evidenti. Anche in seguito all’approvazione della riforma, il costo delle polizze sanitarie è continuato a crescere mediamente del 5% ogni anno
Comparative Health Systems. A New Framework
Full text linkThe book proposes a new theoretical framework for understanding and comparing healthcare systems. This framework is applied to the healthcare systems in twenty-seven OECD countries.
As for the financing side, seven different funding models are introduced: (1) The direct market; (2) Voluntary health insurance; (3) Social health insurance; (4) Targeted programs; (5) Mandatory residence insurance; (6) The universalist model; (7) Medical savings accounts.
Regarding the healthcare provision, two opposing models are outlined: the integrated and the separated models.
The dimensions of healthcare funding and provision are combined with each other. From the intersection of these two dimensions, four families of healthcare systems stand out. The two larger families reflect the traditional contrast between "Social Health Insurance" systems and "National Health Service" systems. The two smaller families are made up, respectively, of countries that have a separated universalist system and countries that adopt the mandatory residence insurance model. From the four families just outlined, three countries are excluded: Greece, Israel and the United States can be considered as "outliers.
Reducing waiting times in the Italian NHS: The case of Emilia-Romagna
Full text linkIn 2015, the Emilia-Romagna Regional Government
implemented a plan to reduce waiting times for elective
outpatient procedures. The objective set by the regional
government establishes that at least 90 per cent of specialist
services are to be provided within the following maximum
waiting times: 30 days for the first specialist
consultation, and 60 days for diagnostic tests. The plan
adopted by the Emilia-Romagna Regional Government is of
particular interest because it encompasses a combined
strategy. Some of the interventions envisaged in the plan
aim at increasing the supply of specialist services. Others
address the demand side, seeking to reduce inadequate
requests and discourage no-shows by patients. And others
focus on combining supply and demand and neutralizing the
effects of some perverse incentives. The Emilia-Romagna
plan appears to have had a successful outcome. In the first
4 years of implementation, the 90 per cent target has not
only been achieved but also widely exceeded
Going universal? The problem of the uninsured in Europe and in OECD countries
Full text linkPurpose: The aim of this article is to address the following questions: (1) Which OECD (The Organization for Economic Co-operation and Development) and EU countries guarantee health insurance coverage to the entire population and which, conversely, leave part of the resident population without cov- erage?, (2) How many people do not have health coverage, and what are their characteristics? and (3) Within the OECD and the EU, is there actually a trend toward universal popula- tion coverage?
Findings: Approximately one third of OECD and European Union countries do not ensure health insurance coverage to the entire population. At present, the uninsured in European Union countries totals more than seven million people. Considering all 36 OECD countries, the uninsured reach almost 48 million.
Conclusion: The diachronic analysis shows that, from the 1970s to present day, the percentage of the uninsured in OECD member countries has gradually decreased. Con- versely, in EU countries, the tendency toward universalism shows a fluctuating trend. Until the mid-90s, the number of uninsured decreased. However, a trend reversal took place and the number of uninsured started to rise again from the second half of the 1990s. The number of individuals without insurance coverage is currently 2-fold higher than the figure recorded before the outbreak of the great financial crisis
Controversial issues in crisis management. Bridging public policy and crisis management to better understand and address crises
Full text linkThe current body of multidisciplinary literature on crisis management still has some unresolved problems. This paper focuses on the following four “controversial issues” in dealing with crises: the usefulness of emergency plans; early signal detection; decision-making amid high uncertainty; and the centralization/decentralization dilemma. The paper first presents the various, contradictory dimensions of these controversial issues, drawing on different strands of organization research, public policy theory, and crisis management studies. Next, these controversial issues are analyzed through the lens of public policy research, drawing specifically on the literature on policy robustness and policy capacities. This theoretical application shows how controversial issues can be framed differently and thus overcome—at least from an analytical and theoretical perspective—confirming that a bridge between crisis management and public policy can be very fruitful in improving our understanding of how crises can be addressed
Le trasformazioni «silenziose» delle politiche sanitarie in Italia e l'effetto catalizzatore della grande crisi finanziaria
Full text linkHealth care policies are part of the national welfare states and have
been involved in the broader trends of welfare reforms of the last decades. They
have been part of the process of recalibration of the Italian welfare, even if they
have not been characterized by dramatic reforms (as it has been the case of pensions
and labour market policies). Health care has remained at the margin of the political
debate but has experienced a trend of incremental and hidden reform. Reforms have
been marked by cost containment measures, and the rationalization of hospital and
care services. The aim of the article is to analyze the impact of the Great Recession
in combination with the renewed EU governance of healthcare and the long-term
austerity trends that have characterized Italian health care. The authors argue that
the policy field has seen the acceleration of policy changes (with the double move
towards recentralization of competences and privatization) in the aftermath of the
crisis. This has happened through a typical «quiet politics», where reforms are set
without any major political and public debate
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