Management and Health Laboratory, Institute of Management and Department EMbeDS, Sant'Anna School of Advanced Studies of Pisa, Piazza Martiri della Libertà 27, 56127, Pisa, Italy; Department of Economics, University of Messina, Italy.
Management and Health Laboratory, Institute of Management and Department EMbeDS, Sant'Anna School of Advanced Studies of Pisa, Piazza Martiri della Libertà 27, 56127, Pisa, Italy.
Health Policy. 2020 Apr;124(4):462-469. doi: 10.1016/j.healthpol.2020.01.012. Epub 2020 Feb 22.
In recent decades, several countries have reformed their health care systems leading to the devolution of power to a lower governance level and, subsequently, to re-centralisation. Due to the ambiguous results of these policies and the start of the financial crisis of 2008, a wide number of national governments implemented cutback initiatives aimed at controlling health expenditure. The literature shows that the introduction of such initiatives may have produced unintended consequences on health systems' performance. In order to better understand the power relations and the resulting decision-making processes between national governments and local authorities, it is important to focus on the effects of such expenditure control mechanisms on the inputs of the health systems, i.e. the production factors. This research aims at investigating the effects of a cutback initiative intended to control personnel costs in a federal Beveridge health system through the analysis of resource allocation at the devolved level. The paper is based on a quantitative analysis of data resulting from the financial statements published by the 21 Italian regional health systems from 2012 to 2017. The results show that, although the Italian regional health systems managed to reduce personnel costs - i.e. hitting the target - the control of the total cost dynamic was not fully addressed. Overall, the initiative implemented by the national government had the effect of limiting the decision-making autonomy of regional authorities, pushing them toward shifting resource allocation from personnel to the purchase of services.
近几十年来，一些国家对其医疗体系进行了改革，将权力下放到较低的治理层级，随后又重新集中。由于这些政策的结果模棱两可，加上 2008 年金融危机的爆发，许多国家政府都采取了削减开支的举措，旨在控制医疗支出。文献表明，这些举措的实施可能对卫生系统的绩效产生了意料之外的后果。为了更好地理解国家政府和地方当局之间的权力关系和由此产生的决策过程，关注这些支出控制机制对卫生系统投入（即生产要素）的影响非常重要。本研究旨在通过分析分权层面的资源配置，调查一项旨在通过控制人员成本来控制联邦贝弗里奇医疗体系开支的削减举措的效果。本文基于对 2012 年至 2017 年 21 个意大利地区卫生系统公布的财务报表数据的定量分析。结果表明，尽管意大利地区卫生系统设法降低了人员成本（即达到了目标），但并未完全解决总成本动态的控制问题。总体而言，国家政府实施的这项举措限制了地区当局的决策自主权，迫使它们将资源从人员配置转移到购买服务上。
