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RPS 1 2018

Il testo è la sintesi dell’articolo pubblicato nella sezione Tema del n. 1 2018 di Rps e scaricabile dagli abbonati nella versione integrale al link:

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health system

Health Cost of Ageing: Truth, Myths and Clichés

in the issue
Nhs
The heavy burden of health spending on elderly care is common-place in the preoccupations of policy makers and politicians, and is constantly the focus of media attention. The attention on this subject is however rather ambivalent: stress is not placed on the «physiology» of growth in investments for a part of society that «obviously» expresses several needs and is entitled to corresponding rights; the objective complexity of the problem is presented in such a way as to make the solutions appear increasingly more difficult and not due, with the consequent rise in cultural, political and cognitive marginalisation. Analysing four model scenarios, operative solutions, feasible through a participatory way, are indicated at both the local and general levels.only subscribers can see the full article

Data-Banks on Health. Towards the Creation of Care Epidemiology

In the face of a growing quantity of reports, information, surveys, statistics, descriptions and projections on so many aspects of the health and social system in our country, we are gradually becoming more and more aware of the limits of such contributions. As a simple example from the various national sources that are easy to access, one might cite all the institutional web sites and/or data banks such as the National Statistical Institute (Istat, see, for example, the Annuario statistico italiano 2006, recently published and available entire online); the Ministry of Health, the Italian Agency of Drug (Aifa); the Istituto Superiore di Sanità; the Istituto Nazionale per l’Assicurazione contro gli Infortuni sul Lavoro; and the Interuniversity Consortium (Cineca - Arno Report). only subscribers can see the full article

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