The impact of health care reforms on the performance evaluation systems State of art – PhD project PhD Student: Milena Vainieri
Tutors: Prof.ssa Sabina Nuti
Prof. Lino CinquiniPhD in Management, Competitiveness and Development
The impact of health care reforms on the performance evaluation systems State of art – PhD project PhD Student: Milena Vainieri
Tutors: Prof.ssa Sabina Nuti
Prof. Lino Cinquini
PhD in Management, Competitiveness and Development
PhD research project
Managerial tools to control public health services among policy choices of centralization, decentralization, competition and cooperation.
Objectives:
Analysis and classification of the reform choices
Analysis and classification of the network of selected countries
Analysis and classification of managerial tools
Analysis of relationships among the previous tiers
Case study: Tuscan Health System
Selection of one or more case study in EU
PhD research project – the first year
PROJECT OF MES LAB
“MANAGERIAL TOOLS
IN AREA VASTA
NETWORK” Analysis and classification of the reform choices of selected countries
Analysis and classification of the network of selected countries
Analysis and classification of managerial tools
Analysis of relationships among the previous tiers
Case study: Tuscan Health System
The case study: Tuscan Health System
REGION CONTROLLERS
LHAs/THs CFO ESTAVs MeS Lab AREA VASTA S.E. REGION CONTROLLERS
LHAs/THs CFO ESTAVs MeS Lab AREA VASTA C. ACTION – RESEARCH APPROACH Monthly meetings.
Objectives:
Map of managerial tools in use within networks
Needs of control REGION CONTROLLERS
LHAs/THs CFO ESTAVs MeS Lab AREA VASTA N.W. ACTION – RESEARCH APPROACH
The case study: the outputs
REGION CONTROLLERS
LHAs/THs CFO ESTAVs Information for program procurement functions
Information flows from and for Regions and LHAs/THs Intranet for procurement services
Periodical meetings Same rules for cost analysis
Mobility budget
Order,Logistic functions Periodical meetings in Area Vasta
Protocols for specific cases Definition of mobility mechanism within the A.V.
Comparison of production and costs for new fares Budget of Mobility 2004 + 2%
Attempt to make a balance sheet per Area Vasta Needs of control Managerial tools of the network
The case study: the outputs
REGION CONTROLLERS
LHAs/THs CFO ESTAVs Information for program procurement functions
Information flows from and for Regions and LHAs/THs Intranet for procurement services
Periodical meetings Same rules for cost analysis
Mobility budget
Order, Logistic functions Periodical meetings in Area Vasta
Protocols for specific cases Definition of mobility mechanism within the A.V.
Comparison of production and costs for new fares
Budget of Mobility 2004 + 2%
Attempt to make a balance sheet per Area Vasta Needs of control Managerial tools of the network BUILDING PROTOCOLS
The case study: the outputs
The case study of the Area Vasta network in Tuscany Region
Findings No managerial tools for networks
Need for managerial tools for networks
Focus on the relationships between ESTAVs and LHAs/THs - Region
The performance evaluation of the ESTAVs.
The case study: the outputs
The performance evaluation of the ESTAVs.
The indicators for rewarding ESTAVs’ CEOs
The creation of an explorative information flow for procurement function (each three month)
The evaluation of ESTAVs by customers
The evaluation of the savings of ESTAV
towards a multidimensional
performance evaluation system
The blind alley
PERFORMANCE EVALUATION OF ESTAV…? … NEW PROJECT OF THE MES LAB… Map and compare the Performance Evaluation Systems across Italian Regional Health Services
The renewal of PhD research project …
Performance Evaluation System Health reforms Managerial tools to control public health services among policy choices of centralization, decentralization, competition and cooperation.
What is not safe: No network analysis, No differences whithin the level of government; no efficiency comparison.
The renewal of PhD research project …
ONE YEAR AGO
Analysis and classification fo the reform choices
Analysis and classification of the network of selected countries
Analysis and classification of managerial tools
Analysis of relationships among Managerial tools – Policy choices and Network
Case study: Tuscan Health System
TODAY
Analysis and classification fo the reform choices
Analysis and classification of the features of Perfomance Evaluation Systems (P.E.S.)
Analysis of relationships among P.E.S. – Health reforms and Performance
Across Italian Regional Health Systems
Across selected OECD Health Systems
The renewal of PhD research project …
PERFORMANCE HEALTH CARE
REFORMS PERFORMANCE
EVALUATION
SYSTEMS Across some OECD Health Systems
Across Italian Regions
The literature review
HEALTH CARE REFORMS
PERFORMANCE EVALUATION SYSTEMS
RELATIONSHIPS AMONG PERFORMANCE – HEALTH REFORMS – PERFORMANCE EVALUATION SYSTEMS
The literature review: Health Care Reforms (1)
International level
European Observatory on Health Care Systems “Decentralization in Health Care” 2007
European Observatory on Health Care System and Policy website
Peer review journals:
Health Policy;
Health Economics… In Italy
Formez “I sistemi di governance dei servizi sanitari regionali” 2007
Annual reports:
Rapporto OASI
Rapporto CEIS
Rapporto Sanità – Fondazione Smith Kline
Other Italian healthcare management journals
The literature review: Health Care Reforms (2)
“FASHION” OF TOPICS IN HEALTH CARE REFORMS:
The evolution of
Regional Health
System 1995 2004 2007 Decentralization
and Recentralization
Periodical comparisons among EU countries
Some specific articles on single country reform IN ITALY… 1992 2000 2007 Focus on LHAs/THs Dimensions Federalism – Devolution
Risk and Opportunities How to assess health reforms
2007 1995
The literature review: Performance Evaluation Systems in Health Care
At international level
National reports
Broad literature that:
Describes experiences;
Points out conceptual framework on performance measurement systems:
PATTERNS
PROCESSES
At national level
Balanced Scorecard in LHAs/THs
Italian regional Health Care Agency (Agenas) 2008 (few Regions)
Regional experiences and reports
The literature review: The relationships
PERFORMANCE HEALTH CARE
REFORMS PERFORMANCE
EVALUATION
SYSTEMS Many papers and researches
Framework
Assessment
European
Observatory
and Formez Many papers and researches:
Focus on Hospital
Focus on NHS Some papers and researches:
Focus on Hospital
Up to now I haven’t found a paper on the relationship at an upper level
Up to now
I haven’t found a
research that puts together
These 3 elements
Looking for closing the gap of relationships
PERFORMANCE HEALTH CARE
REFORMS PERFORMANCE
EVALUATION
SYSTEMS Many papers and researches
Framework
Assessment
European
Observatory
and Formez Many papers and researches:
Focus on Hospital
Focus on NHS Some papers and researches:
Focus on Hospital
Up to now I haven’t found a paper on the relationship at an upper level
Up to now
I haven’t found a
research that puts together
These 3 elements Some papers and researches:
Focus on Hospital
Look fot the relationship at an upper level
Put together
These 3 elements
Research questions
Are there any relationships among Health Care Reforms and Performance Evaluation Systems (P.E.S.) at Regional or National level?
The interaction effect of Health Care Reforms and P.E.S. on the Performance
Methodology (1)
Preliminary steps
To identify and classify the features of the Performance Evaluation System of OECD Health Systems and Italian Regional Health Systems
To identify and classify the features of Health Care Reforms of OECD countries and Italian Regional Health Systems
Literature and reports available
Interviews with Regional Italian Councillors and other Policy makers.
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