“…9 In the last few years, scholars and managers have focused a great deal of attention on the Balanced Scorecard as a strategic management tool supporting public administrations. [10][11][12][13] Methods The Balanced Scorecard approach in public health care: a proposal The strategic environment in which the Regional Government Health Department and public health care providers operate, in addition to the limited ability of these two players to fully exercise their discretionary powers in defining strategic actions, make it difficult to apply the Balanced Scorecard or, at least, to apply some of the scorecard's perspectives. By analysing, in particular, the three sections of the Balanced Scorecard (Table 1), 14 it becomes clear that the Health Department is only able to fully exercise its discretionary powers (according to the guidelines indicated in the Regional Public Health Plan) in defining the Strategy Map and Measures Section of the Balanced Scorecard, whereas a series of problems inherent in the Targets section of the Balanced Scorecard and the Action Plan limit its discretionary powers.…”