Performance and Expenditure in Public Health-care Organizations

The Italian healthcare service is based on a solidarity approach, according to which all citizens have free access to a set of medical treatments, regardless of personal income or geographical distribution. This approach... [ view full abstract ]

The Italian healthcare service is based on a solidarity approach, according to which all citizens have free access to a set of medical treatments, regardless of personal income or geographical distribution. This approach requires a high level of resources and health spending in Italy at national level is about 9.1% of GDP in 2015, in line with the OECD average (9%) and it is mainly public (77%, vs 73% of the OECD average) (OECD, 2015).
The Healthcare sector is one of the most important in terms of overall expenditure in the Sardinia Regional Government where it accounts for over 50% of the budget. Similar situations are reported in the other Italian Regions (to which level of government the actual management of the health service is assigned).
The reduction of the available resources has brought to a search for a reduction of expenditure and of inefficiencies and these changes have also been accompanied by the attempt to structurally change the Italian healthcare service, at both national and regional level. After a major reform in 1978 that introduced the universal coverage for all Italian citizens, other fundamental reforms took place in 1992 and in 1999. The main aims of these two last reforms were to increase the autonomy of the Regions and increase efficiency and effectiveness. This national legislation sets out the general rules and guidelines to be followed to reforming the health service. Then, the actual implementation of these rules and guidelines is left to the autonomy of the individual Regions. As a consequence, notwithstanding a national framework, every one of the 20 Italian regions has taken individual choices to shape their regional health service. These decisions regarded both the overall system at regional level and each individual health trust.
This paper investigates the connections between performance achieved by public health-care organizations in Sardinia and the changes in the funding systems. More specifically, we are interested in understanding if and to what extent the changes in the funding systems that took place over the last 15 years have had an impact on the performance of public health care organizations. Using two data sets on (1) the expenditure of eight health trusts based in the region of Sardinia (Regional Public Accounts - RPA) and (2) a set of indicators to measure performance prepared under a national program called “Programma Nazionale Esiti”, which provides data at the level of individual health trust in all Italian Regions, we analyzed how performance is related to expenditure. The paper reports on the first results of this analysis.