APPLYING THE IMPACT ANALYSIS TO THE EVALUATION OF PRIMARY HEALTH CARE DECENTRALISATION: EXPERIENCES AND PERCEPTIONS ON THE QUALITY OF CARE.

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1 APPLYING THE IMPACT ANALYSIS TO THE EVALUATION OF PRIMARY HEALTH CARE DECENTRALISATION: EXPERIENCES AND PERCEPTIONS ON THE QUALITY OF CARE. Maria Laura Toraldo Introduction The Italian Healthcare public system has to be framed in the more ample study of public administrations which in Italy have been facing an obscure phase due to the current public reforms and the ongoing governmental financial cuts which gradually are undermining its base. Despite this, the relevance and centrality of a national provision healthcare system is universally unquestioned and taken for granted and in the Italian context, a strong debate aimed to claim its survival is now in progress. In such turbulent context, we assume that over the past years there has occurred a need for accountability of public decisions making and a calling for tools and instrument based on clear evidences and analysis. Indeed, as stated by Jones (2001) referring to the application of economic evaluation to the UK Health services, the ongoing healthcare reform and the scarcity of resources for funding public services has increasingly forced economics into the mind of all decision makers who will be held more and more accountable for the effectiveness of their economic and quality outcomes. This article explores the concept of socio-economic impact analysis and aims to show the contribution that this category could provide as instrument for the evaluation of public choices within the healthcare sector. Specifically, this article aims to investigate the impact of decentralization on the quality of the primary health care services, taking the experience of a Local Health Unit (ASL) in Campania. More to the point, in this paper will be investigated the experiences and perceptions of the users and suppliers in an effort to understand how the delegation of authority and responsibility to the local levels could impact on the cost containment without impairing the quality of care. 1

current public reforms and the ongoing governmental financial cuts which gradually are undermining its base.

2 Research design According to Radich (1987), the economic and social impact of a given phenomenon can be defined as the effect of that phenomenon on economic and social factors such as the economic behaviour of consumers, businesses, firms (micro-level) and on the economy as a whole, national wealth or income, employment, and capital (macro-level) (Radich, 1987). So far, the more relevant dimension traditionally considered has been the evaluation of the direct, indirect and induced economic impact. The quantitative approach has revolved around the evaluation of the direct expenditure through the balance sheet analysis in order to identify different categories of expenditure and giving a possible grid of interpretation. I argue that this approach should be expanded by including the less quantifiable dimensions. What I propose is a methodology of analysis that will include the perceptions of the users and suppliers which receive the health care. An illustrative case will be presented, which is part of a broader doctoral thesis. In accordance with the object of the study, qualitative data collection methods have been chosen to gain an understanding of the phenomenon. These included semi-structured interviews, observation and document analysis. Through them, it will be possible to describe the effects of health policies decentralisation on the quality of the services, in terms of access, social commitment, participation and services delivery. By this way, I want to give an answer to the main statement that within the topic of economic and social impact analysis the main problem could be refining measurement techniques. Understanding the experiences and perceptions of users and providers would give insights into the limits and opportunities on the evaluation of healthcare interventions and initiatives. References Adinolfi, P., & Mele, R Elementi di Management sanitario. Kastalia Multimedia. Adinolfi, P L'evoluzione organizzativa delle aziende sanitarie pubbliche. Mecosan, 37. Antonelli, G., Mollona, E. e L. Moschera, (2010), Dinamiche evolutive in un cluster di produzione: una simulazione dei processi di interazione strategica e collaborazione, in Boari, C. (a cura di) Dinamiche evolutive nei cluster geografici di imprese, Il Mulino, Bologna 2

So far, the more relevant dimension traditionally considered has been the evaluation of the direct, indirect and induced economic impact.

3 Borgonovi E Conclusioni in G. Zuccatteli, C. Carbone, F. Lecci (ed.) Trent anni di Servizio Sanitario Nazionale. Il punto di vista di un manager, pp , Egea, Milano. Berni A. (2009), I modelli organizzativi dei sistemi di controllo, cap 4, in Garzella S., Mancini D, Moschera L., Sistemi di controllo interno e soluzioni organizzative, Giappichelli, Torino. pp ISBN: Berni A., Cicellin M., Galdiero C. (2009) Partnership pubblico-private nel settore sanitario italiano. Tra opportunità di cambiamento e integrazione di logiche. Proceedings of the X Workoshop dei Docenti e Ricercatori di Organizzazione Aziendale, Università degli Studi di Cagliari, April Borgonovi E., Fattore G., Longo F., Management delle istituzioni pubbliche, Milano, Egea. Borgonovi, E La tutela della salute è il fine, il funzionamento dei sistemi e delle aziende è il mezzo, Milano, Egea. Capital Link The economic impact of community health centers in the Philadelphia area. December. Cicellin M., Consiglio S., Galdiero C., Does the employment contract make them different? Diversity management and identity of temporary agency nurses in the Italian healthcare, Proceedings della 7th International Critical Management Studies Conference, Napoli, luglio 2011, ISBN: de Vita P., Martinez M. (2001), «Flessibilità e performance dei sistemi di public utilità». Costa G. (a cura di). Flessibilità e performance. L organizzazione aziendale tra old e new economy, ISEDI, Torino de Vita, P., Mercurio, R., Testa, F. (a cura di), (2007). Organizzazione Aziendale: assetto e meccanismi di relazione, Torino, Giappichelli. Galdiero C., Cicellin M. (2009) L evoluzione dei modelli di governance nel sistema sanitario italiano, pp , in (a cura di) Mercurio R., Martinez M. Modelli di governance e processi di cambiamento nelle public utilities, FrancoAngeli, ISBN Galdiero C., Cicellin M. (2009), Soft coordination mechanisms to integrate institutional logics in healthcare PPPs, Mecosan, special issue, n. 71, pp Galdiero C., Cicellin M. (2008) Process of institutional change and Public-Private Partnership in the Italian Healthcare sector. Proceedings of the III Workshop on Organisational Change & Development: Advances, Challenges & Contradictions, Bucarest, Romania, September

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Martinez M, Jamison, M Tillmar M (2011) Public utilities corporate governance, Journal of Management and Governance Online First, December Martinez M., Galdiero C., Perrini M., Mercurio R., Cerbo M.

5 Moschera Luigi, Antonelli Gilda, (2006), Regolazione istituzionale e strategie dei singoli attori per la competitività di un cluster, in Mercurio R. (a cura di), Organizzazione, regolazione e competitività, McGraw Hill, Milano; Saltman, R., Bankauskaite, V., and Vrangbæk, K Decentralization in health care: strategies and outcomes. Open University Press. Saltman, R. B Decentralization, re-centralization and future European health policy. European Journal of Public Health, 18 (2) pp Jones, A The economic evaluation of healthcare: the appliance of science. International Journal of medical marketing, 1 (4) pp Wheeler, N., Proctor, T Strategy analysis in the health service. Journal of Marketing Management, es=9 - v99 (3) pp

Open University Press. Saltman, R. B. 2008. Decentralization, re-centralization and future European health policy. European Journal of Public Health, 18 (2) pp. 104-106. Jones, A. 2001.

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