Making governance work in the health care sector: evidence from a ‘natural experiment’ in Italy

Abstract

The Italian Health care System provides universal coverage for comprehensive health services and is mainly financed through general taxation. Since the early 1990s, a strong decentralization policy has been adopted in Italy and the state has gradually ceded its jurisdiction to regional governments, of which there are twenty. These regions now have political, administrative, fiscal and organizational responsibility for the provision of health care. This paper examines the different governance models that the regions have adopted and investigates the performance evaluation systems (PESs) associated with them, focusing on the experience of a network of ten regional governments that share the same PES. The article draws on the wide range of governance models and PESs in order to design a natural experiment. Through an analysis of 14 indicators measured in 2007 and in 2012 for all the regions, the study examines how different performance evaluation models are associated with different health care performances and whether the network-shared PES has made any difference to the results achieved by the regions involved. The initial results support the idea that systematic benchmarking and public disclosure of data are powerful tools to guarantee the balanced and sustained improvement of the health care systems, but only if they are integrated with the regional governance mechanisms.

Rethinking Healthcare Performance Evaluation Systems towards the People-Centredness Approach: Their Pathways, their Experience, their Evaluation

“…The main challenge is to adopt this perspective in the performance evaluation systems (Nuti et al 2016a).…”

“…While it is clear that the fragmentation of care is a challenge both for patients and for healthcare services providers (Coleman and Berenson 2004), some initial evidence is available on the contribution of cross-sectoral patient data on the identification and evaluation of quality gaps in the continuum of healthcare service delivery (Noest et al 2014;Nuti et al 2010Nuti et al , 2017a. In particular, pathway-related data can help to overcome a silo-vision of healthcare and to promote a personalized medicine approach, also improving the overall quality of care pathway for each patient in terms of outcomes (Nuti et al 2016a).…”

“…To assess and manage the overall healthcare system performance, the experiment carried out in Tuscany (Italy), and shared with other Italian Regions (Network of Italian Regions 2016; Nuti et al 2016aNuti et al , 2016b, suggests the introduction of new measurement mechanisms. These mechanisms enable assessing the performance of a network of healthcare service providers involved in the same care pathway, also thanks to effective graphical representations.…”

“…This experiment was also shared with the other 12 Italian Regions that are actually part of a network that voluntarily adopted the healthcare performance evaluation system by re-organizing the PMS from the "single setting" to the "patient pathway" approach. This measurement of healthcare performance was applied to several significant care pathways, such as oncology and chronic diseases (Network of Italian Regions 2016; Nuti et al 2016aNuti et al , 2016b.…”

“…• by defining targets both for CEOs and healthcare unit managers (Nuti et al 2016a); • by checking the standards achievement in the accreditation system for healthcare services/pathways (Murante and Nuti 2012).…”