A Legal Case Study as a Testing Ground for AI’s Role in Aligning NPM Theory and Practice in Italian Healthcare

Abstract

This paper critically examines the enduring chasm between New Public Management (NPM) theory and its practical failure within the Italian healthcare system, using a detailed legal case study as a stark illustration. Despite the formal adoption of NPM principles through Italian Legislative Decree no. 502/1992, systemic bureaucratic resistance and deeply entrenched practices are demonstrably shown to have not merely hindered, but effectively nullified their implementation. The case study reveals a profound and systemic bureaucratic inertia that consistently overrides NPM reforms at every level, leading to persistent inefficiencies and significant resource depletion. In light of this fundamental failure of conventional control mechanisms and theoretical frameworks, this study explores the disruptive potential of Artificial Intelligence (AI), particularly recent advancements in reasoning-oriented Large Language Models (LLMs). AI is not presented as a mere advisory tool or another incremental reform, but as a potentially inescapable and structural element for transforming decision-making processes. While initial tests with LLMs indicate their capacity to offer timely and reasoned guidance, the core argument advances beyond simple implementation of NPM principles. The analysis ultimately posits that AI's true disruptive power lies in its ability to become an indispensable component of the administrative system itself, fundamentally altering the landscape of public administration and healthcare by overcoming previously insurmountable barriers between theory and practice in ways that conventional approaches have consistently failed to achieve.