The impact of health care reforms on the performance evaluation systems State of art – PhD project

1. PhD in Management, Competitiveness and Development The impact of health care reforms on the performance evaluation systemsState of art – PhD project PhD Student: Milena Vainieri Tutors: Prof.ssa Sabina Nuti Prof. Lino Cinquini

2. 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

3. 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 PhD research project – the first year PROJECT OF MES LAB “MANAGERIAL TOOLS IN AREA VASTA NETWORK”

4. REGION REGION CONTROLLERS LHAs/THs CONTROLLERS LHAs/THs CFO ESTAVs CFO ESTAVs MeS Lab MeS Lab AREA VASTA C. AREA VASTA N.W. AREA VASTA S.E. The case study: Tuscan Health System ACTION – RESEARCH APPROACH ACTION – RESEARCH APPROACH REGION • Monthly meetings. • Objectives: • Map of managerial tools in use within networks • Needs of control CONTROLLERS LHAs/THs CFO ESTAVs MeS Lab

5. The case study: the outputs REGION CONTROLLERS LHAs/THs CFO ESTAVs

6. The case study: the outputs REGION CONTROLLERS LHAs/THs BUILDING PROTOCOLS CFO ESTAVs

7. 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.

8. 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

9. The blind alley PERFORMANCE EVALUATION OF ESTAV…? • Map and compare the Performance Evaluation Systems across Italian Regional Health Services … NEW PROJECT OF THE MES LAB…

10. The renewal of PhD research project … Managerial tools to control public health services among policy choices of centralization, decentralization, competition and cooperation. Performance Evaluation System Health reforms

11. 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 …

12. PERFORMANCE • Across some OECD Health Systems • Across Italian Regions HEALTH CARE REFORMS PERFORMANCE EVALUATION SYSTEMS The renewal of PhD research project …

13. The literature review • HEALTH CARE REFORMS • PERFORMANCE EVALUATION SYSTEMS • RELATIONSHIPS AMONG PERFORMANCE – HEALTH REFORMS – PERFORMANCE EVALUATION SYSTEMS

14. 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 (1)

15. The literature review: Health Care Reforms (2) “FASHION” OF TOPICS IN HEALTH CARE REFORMS: Decentralization and Recentralization How to assess health reforms 1995 1995 2004 2007 Periodical comparisons among EU countries Some specific articles on single country reform IN ITALY… 1992 2000 2007 2007 The evolution of Regional Health System Federalism – Devolution Risk and Opportunities Focus on LHAs/THs Dimensions

16. 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: Performance Evaluation Systems in Health Care

17. The literature review: The relationships PERFORMANCE • Many papers and researches • Framework • Assessment • European • Observatory • and Formez • Many papers and researches: • Focus on Hospital • Focus on NHS Up to now I haven’t found a research that puts together These 3 elements HEALTH CARE REFORMS PERFORMANCE EVALUATION SYSTEMS • Some papers and researches: • Focus on Hospital • Up to now I haven’t found a paper on the relationship at an upper level

18. Looking for closing the gap of relationships PERFORMANCE • Many papers and researches • Framework • Assessment • European • Observatory • and Formez • Many papers and researches: • Focus on Hospital • Focus on NHS Up to now I haven’t found a research that puts together These 3 elements Put together These 3 elements HEALTH CARE REFORMS PERFORMANCE EVALUATION SYSTEMS • Some papers and researches: • Focus on Hospital • Look fot the relationship at an upper level • Some papers and researches: • Focus on Hospital • Up to now I haven’t found a paper on the relationship at an upper level

19. 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

20. 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.

21. R.Q. 1 Y = f(Xi)+e Y: features of P.E.S. Xi: features of Health Reforms Cross sectional analysis (regression analysis) R.Q. 2 Y = aiX1i+bjX2j+ c(X1*X2)+e Y: Performance X1i: Features of Health Reforms X2j: Use of P.E.S. Time series analysis Methodology (2) Preliminary basic statistics Preliminary basic statistics

22. Possible difficulties • The R.Q. 2 -. The“use” of P.E.S. The “features” of P.E.S. • The R.Q. 2 – Difficulty to collect data for time series analysis qualitative analysis

23. Timing of the research work • REVIEW OF LITERATURE • REGIONAL ITALIAN HEALTH SYSTEM • Interviews with Councillors and Head of Health Regional Departments • Focus group with CEO of LHAs/THs • National Workshop • Selection of OECD HEALTH SYSTEMS (Ontario -Comunidad Valenciana…) and gathering data • CLASSIFICATION OF FEATURES • MODELS TO ANALYZE RELATIONSHIPS

24. Deliverables • The review of literature and the classification of P.E.S. and Health Care Reforms (Positioning paper) • A cross sectional analysis of the Performance Evaluation System across Italian Regions (December 2008) • The findings of the overall research …or… • Comparing 2-3 case-studies (the Tuscan - Ontario or Comunidad Valenciana Health Systems)

25. Comments and suggestions… …are really welcome.