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RPS 4 2017

Dopo l’ondata migratoria del secondo dopoguerra, l’emigrazione italiana si è attenuata ma mai esaurita e negli ultimi anni ha conosciuto una ripresa delle partenze sempre più consistente.

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health system

Mafias and Grey Areas in the Health Service

Articolo scritto da:

The Mafia is interested in the health service for many reasons – money-laundering, treatment for criminals on the run, and social and political influence. But the health service is tempting to other types of criminal cartels too – consisting of businessmen, members of the professions, doctors, managers of the public services and politicians – with whom the Mafia can cooperate, though not always successfully. The empirical evidence the article draws on concerns the cases of two health authorities that have been disbanded as a result of mafia infiltration: Locri (2005) and Reggio Calabria (2008). Challenging the common view that the Mafia is able to control all the social relations it enters into, the conclusion is that the outcome in the health service is not necessarily predictable, but depends to a great extent on the opportunities and constraints of each of the categories of participants. Traduzione dall’italianoonly subscribers can see the full article
Keywords: 'ndrangheta :: gray area :: health system ::

Universalism and Technological Development: Germany, the Uk and the Usa

Articolo scritto da:

in the issue
Nhs
The paper gives an overview of the historical evolution and characteristics of the s in Germany, the Uk and the Usa. The article also proposes an economic interpretation of differences between the three countries. Germany and the Uk, through different models, assure universal access to health services. In the Usa the residual role of public funding doesn’t manage to make up for shortcoming in the private sector, leaving almost a third of the population without any insurance or with insufficient insurance coverage. High health spending in the Usa, incrementing the diffusion of increasingly expensive new technologies and therapeutic approaches, can put universalistic systems under pressure. To maintain the present structure of European health systems, it is necessary to manage the diffusion of new technologies.only subscribers can see the full article

The Structuring of Regional Health Services and the Governance of the Health System

Articolo scritto da:

in the issue
Europe and Regions
In the 1990s decentring the national health service was the signal for processes of institutional differentiation between the Regions, from which emerged three models of governance for the health system. In recent years, however, most of the Regions have partially converged on regulatory solutions based on principles of cooperation and integration between the health organisations, pursued through negotiating or centralised planning. This trend is probably a response to the common problem of control of expenditure and financial retrenching, which, in the most critical cases, risks heavily conditioning regional autonomy, setting off process of recentralisation of the health service.only subscribers can see the full article
Keywords: Italy :: devolution :: health system ::

Rare Diseases as an Example of Contrasting Marginality

Articolo scritto da:

in the issue
Nhs
Rare diseases are an heterogeneous set of human pathologies whose common features are the low frequency rate in the population (under 5:10,000, according to European criteria) and serious social and health problems associated with such a low frequency. Their number involves a consistent part of the population (approx. 6,000). These pathologies are little known and studied, often chronic and crippling, for which social and health interventions must include support for life and work choices to persons affected. Important public health initiatives are underway at both the national and international levels.only subscribers can see the full article

The Costs of the Failure to Integrate Social and Health Care

Articolo scritto da:

That health service costs tend to increase staggeringly is well known. The most recent forecast of PricewaterhouseCoopers Health Research Institute estimates a tripling of its impact on Gdp in the next fifteen years, reaching 21% in the USA and an average of 16% in other OECD countries. Italy’s relatively favourable position at 8.5% will tend to be eroded, if for no other reason than the worldwide tendency of health service consumption, supply systems and costs to converge. only subscribers can see the full article

Italian Health System: Work in Progress between Decentralization and the Impact of the Eu

Articolo scritto da:

in the issue
Nhs
The crisis of the State-nation led to a consolidation of sub-national levels of government. This reinforcement has conditioned recent developments in the welfare state, and particularly in health policy. With reference to the Italian case, the article illustrates the main changes brought into force by the reforms of 1992-93 and of 1999 in terms of the «regionalization» of the health system, and outlines the main steps that led to fiscal federalism, enhancing regional financial autonomy. The closing paragraph takes into consideration possible implications of the process of European integration and, more specifically, the adoption of the Open method of co-ordination on the evolution of the regional health systems.only subscribers can see the full article

Italy. National and Regional Health System: Debts and Equity

Articolo scritto da:

in the issue
Europe and Regions
Tax federalism in Italy is closing in on us, while the gap between North and South increases. In the welfare system the gap concerns both essential levels of services as well as the economic-financial situation. Analysing the balance sheets of recent years and some indicators of the state of organisation of the regional health services, we can see how the deficit in many Regions is not due to under-financing so much as to different planning and organisational choices. In the less virtuous Regions there is an extremely close link between deficits and distortions in services, while in the more virtuous Regions the positive balance results are accompanied by indicators that show better organisation and greater appropriateness. This is confirmed by the plans of the six Regions with serious deficits for dealing with the situation. This shows the importance of local governance and at the same time the need, particularly in a federal country, for strong national control to guarantee uniform essential services throughout the country. only subscribers can see the full article

Towards the Reinterpretation of the Managed Competition Model?

Articolo scritto da:

in the issue
Nhs
During the 90s, the managed competition model, or quasi-market, was the main reference for the reform of European health systems. The concrete application of this organisational model - aimed at reallocating incentives between financiers, producers and users to guarantee the appropriateness of services, the costs containment and the efficient allocation of resources - has occurred even with numerous variants from the starting proposal and through reforms that followed one another discontinuously, at times emphasising and at other times undermining the pro-competition objectives. In this perspective, the paper proposes an analysis of the reforms experienced over the past few years in England and Italy and investigates the reasons that encouraged these countries to progressively reduce the role of competition, preferring negotiated schemes that were considered to be more compatible with solidarity principles that characterized European public health systems.only subscribers can see the full article

Betty Leone

Articolo scritto da:

I welcome the decision to devote a session of the seminar on health and welfare policies to issues related to a proper definition of informative system aimed to transferring knowledge among health workers, and from them to the general public, and vice versa. The debate is not new. On the contrary, it characterized the ’70’s and ’80’s in the period of health service reform and it was later taken up again during the discussions that led to the law (no. 328/2000) on welfare reform. Indeed, it is clear that this subject meets various needs. The first is that of identifying the needs to which we are to respond: this is an essential function if the services are not to fall into a merely self-referential logic rather than responding to the need to meet the general public’s requirements effectively. only subscribers can see the full article

Health Spending: Proposals for a New State-Region Pact in Italy

Articolo scritto da:

in the issue
Nhs
In the paper the author analyses the Italian Health spending in relation to public spending, and proposes a new accountability pact between central government and the regions, aimed at relaunching the National Health Service. Following an historical overview of the foundation of the Nhs and the reforms in the 70s and 90s, the relation between funding and spending from 1999 to 2004 is analysed in the light of documents produced by Institutions and Research Institutes, and compared with other European countries. The paper also presents a detailed analysis of health legislation concerning the regions adherence to the Stability Pact, the agreements signed at the State-Region Conference and the critical financial situations presently registered. Lastly, it examines article 119 of Title V of the Constitution and the new funding system of local authorities which it introduces.only subscribers can see the full article