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ENZO BIVONA

Designing a Dynamic Performance Management System to outline patients mobility policies

  • Autori: Bivona, E.
  • Anno di pubblicazione: 2015
  • Tipologia: Capitolo o Saggio (Capitolo o saggio)

Abstract

In the Italian health care service, both public and private providers operate through the coordination of Local Health Authorities (Lhas). Such authorities, together with the regional government, are in charge to make sure citizens can access locally to a predefined health care service level. However, patients are free to move from one region to another to receive the requested health care service. This phenomenon is recognised as patients mobility. Palm and Glinos [2010] identified some of the reasons why patients decide to seek care elsewhere, such as the specific situation of the patient, the medical need and the availability (or not) of the care service at home. A patient treated in a region different from the one where he/she resides implies that the region delivering the health care service is financially compensated for the medical treatment provided. On an annual basis, such financial resources are transferred by the State to every single region, net of health care services residents received in other regions. If on one hand, such a mutual system allows the patients to free decide where to take a given health care treatment and it represents a strength of the National health care system, on the other hand at regional government level such decision is not free of consequences, at least for three main reasons. First, the annual amount of money transferred to some regions can range from Eur 200 Million up to Eur 350 Million. Such figures, particularly in recession times, may raise a high pressure on public decision-makers as they represent a loss of economic growth opportunities for the region. Second, it leads to additional – difficult to quantity – social costs (e.g., travel and accommodation costs for both the patients and the accompanying person/s, and the related loss of working days for the medical treatment) citizens have to sustain to get the desired health care treatments in another Region. Finally, it raises at the regional level a series of issues on how to plan sustainable care. In fact, some Regions may receive considerable flows of patients for particular medical treatments making uncertain quality, liability, safety and even the ethical dimension of health care treatments. As relatively little is known about patient mobility flows and how to effectively tackle it at the regional level, this work aims to contribute to addressing the following main research questions: – What are the main causes underlying passive patients mobility? – How can Local Health Authority’ managers design effective patients mobility policies? How can they gauge policy sustainability in the medium-long term horizon? – What is the role of public and private health care providers should take to prevent local patients mobility? To answer the above research questions, an inter-institutional perspective is suggested to design a Dynamic Performance Management System to support the Local Health Authority’s Managers in outlining patients’ mobility policies. To this aim, an analysis of a Local Health Authority based in a Sicilian Province is provided.

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