Bruzzi Silvia, Ivaldi Enrico, Santagata Marta
Department of Economics, University of Genoa, Genoa, Italy.
Department of Political Sciences, University of Genoa, Piazza Emanuele Brignole 3a canc, Genoa, Italy.
Soc Indic Res. 2022;159(3):1057-1084. doi: 10.1007/s11205-021-02775-8. Epub 2021 Aug 30.
Given the regional disparities that historically characterize the Italian context, in this paper we propose a framework to evaluate the regional health care systems' performance in order to contribute to the debate on the relationship between decentralisation of health care and equity. To investigate the regional health systems performance, we refer to the OECD Health Care Quality Indicators project to construct of a set of five composite indexes. The composite indexes are built on the basis of the non-compensatory Adjusted Mazziotta-Pareto Index, that allows comparability of the data across units and over time. We propose three indexes of health system performance, namely Quality Index, Accessibility Index and Cost-Expenditure Index, along with a Health Status Index and a Lifestyles Index. Our framework highlights that regional disparities still persist. Consistently with the evidence at the institutional level, there are regions, particularly in Southern Italy, which record lower levels of performance with high levels of expenditure. Continuous research is needed to provide policy makers with appropriate data and tools to build a cohesive health care system for the benefit of the whole population. Even if future research is needed to integrate our framework with new indicators for the calculation of the indexes and with the identification of new indexes, the study shows that a scientific reflection on decentralisation of health systems is necessary in order to reduce inequalities.
鉴于历史上意大利国情所具有的地区差异，在本文中我们提出一个框架来评估地区医疗保健系统的绩效，以便为有关医疗保健分权与公平之间关系的辩论做出贡献。为了调查地区医疗系统的绩效，我们参考经合组织医疗保健质量指标项目构建了一套由五个综合指数组成的指标体系。这些综合指数是基于非补偿性的调整后的马齐奥塔 - 帕累托指数构建的，该指数使得数据在不同单位之间以及不同时间具有可比性。我们提出了三个医疗系统绩效指数，即质量指数、可及性指数和成本 - 支出指数，以及一个健康状况指数和一个生活方式指数。我们的框架突出表明地区差异仍然存在。与机构层面的证据一致，有些地区，特别是意大利南部的地区，在支出水平较高的情况下绩效水平却较低。需要持续开展研究，为政策制定者提供适当的数据和工具，以构建一个惠及全体民众的凝聚性医疗保健系统。即使未来需要开展研究，以便将我们的框架与用于计算指数的新指标以及新指数的识别相结合，但该研究表明，对医疗系统分权进行科学思考对于减少不平等现象是必要的。
