the impact of health care reforms on the performance evaluation systems state of art – phd project...
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The impact of health care reforms on the performance evaluation systemsState of art – PhD project
PhD Student: Milena Vainieri
Tutors: Prof.ssa Sabina Nuti Prof. Lino Cinquini
PhD in Management, Competitiveness and Development
Milena Vainieri - Volterra,09 june 2008
PhD research project Managerial tools to control public health services
among policy choices of centralization, decentralization, competition and cooperation.
Objectives: Analysis and classification of the reform choices Analysis and classification of the network of selected
countries Analysis and classification of managerial tools Analysis of relationships among the previous tiers
Case study: Tuscan Health System
Selection of one or more case study in EU
Milena Vainieri - Volterra,09 june 2008
PhD research project – the first year Analysis and classification of the
reform choices of selected countries
Analysis and classification of the network of selected countries
Analysis and classification of managerial tools
Analysis of relationships among the previous tiers
Case study: Tuscan Health System
PROJECT OF MES LAB“MANAGERIAL TOOLS
IN AREA VASTA NETWORK”
Milena Vainieri - Volterra,09 june 2008
The case study: Tuscan Health System
REGION
CONTROLLERSLHAs/THs
CFO ESTAVs
MeS Lab
AREA VASTA S.E.
REGION
CONTROLLERSLHAs/THs
CFO ESTAVs
MeS Lab
AREA VASTA C.
ACTION – RESEARCH APPROACH
Monthly meetings.
Objectives:
• Map of managerial tools in use within networks
• Needs of control
REGION
CONTROLLERSLHAs/THs
CFO ESTAVs
MeS Lab
AREA VASTA N.W.
ACTION – RESEARCH APPROACH
Milena Vainieri - Volterra,09 june 2008
The case study: the outputs
REGION
CONTROLLERSLHAs/THs
CFO ESTAVs
Managerial tools of the network
Needs of control
Budget of Mobility 2004 + 2% Attempt to make a balance
sheet per Area Vasta
Definition of mobility mechanism within the A.V.
Comparison of production and costs for new fares
Periodical meetings in Area Vasta
Protocols for specific cases
Same rules for cost analysis Mobility budget Order,Logistic functions
Intranet for procurement services Periodical meetings
Information for program procurement functions Information flows from and for Regions and LHAs/THs
Milena Vainieri - Volterra,09 june 2008
The case study: the outputs
REGION
CONTROLLERSLHAs/THs
CFO ESTAVs
Managerial tools of the network
Needs of control
Budget of Mobility 2004 + 2% Attempt to make a balance
sheet per Area Vasta
Definition of mobility mechanism within the A.V.
Comparison of production and costs for new fares
Periodical meetings in Area Vasta
Protocols for specific cases
Same rules for cost analysis Mobility budget Order, Logistic functions
Intranet for procurement services Periodical meetings
Information for program procurement functions Information flows from and for Regions and LHAs/THs
BUILDING PROTOCOLS
Milena Vainieri - Volterra,09 june 2008
The case study: the outputsThe case study of the Area Vasta network in
Tuscany RegionFindings No managerial tools for networks
Need for managerial tools for networks
Focus on the relationships between ESTAVs and LHAs/THs - Region
The performance evaluation of the ESTAVs.
Milena Vainieri - Volterra,09 june 2008
The case study: the outputsThe performance evaluation of the ESTAVs.
The indicators for rewarding ESTAVs’ CEOs The creation of an explorative information
flow for procurement function (each three month)
The evaluation of ESTAVs by customers The evaluation of the savings of ESTAV
towards a multidimensional performance evaluation system
Milena Vainieri - Volterra,09 june 2008
The blind alley
PERFORMANCE EVALUATION OF ESTAV…?
… N
EW PROJECT OF THE M
ES
LAB…
Map and compare the Performance Evaluation Systems across Italian Regional Health Services
Milena Vainieri - Volterra,09 june 2008
The renewal of PhD research project …
Managerial tools to control public health services among policy choices of centralization, decentralization, competition and cooperation.
Performance Evaluation
SystemHealth
reforms
Milena Vainieri - Volterra,09 june 2008
The renewal of PhD research project …ONE YEAR AGO Analysis and classification fo
the reform choices Analysis and classification of
the network of selected countries
Analysis and classification of managerial tools
Analysis of relationships among Managerial tools – Policy choices and Network
Case study: Tuscan Health System
TODAY Analysis and classification fo
the reform choices Analysis and classification of
the features of Perfomance Evaluation Systems (P.E.S.)
Analysis of relationships among P.E.S. – Health reforms and Performance
Across Italian Regional Health Systems
Across selected OECD Health Systems
Milena Vainieri - Volterra,09 june 2008
The renewal of PhD research project …
PERFORMANCE
HEALTH CARE REFORMS
PERFORMANCEEVALUATION
SYSTEMS
- Across some OECD Health Systems
- Across Italian Regions
Milena Vainieri - Volterra,09 june 2008
The literature review
HEALTH CARE REFORMS
PERFORMANCE EVALUATION SYSTEMS
RELATIONSHIPS AMONG PERFORMANCE – HEALTH REFORMS – PERFORMANCE EVALUATION SYSTEMS
Milena Vainieri - Volterra,09 june 2008
The literature review: Health Care Reforms (1)International level European Observatory on
Health Care Systems “Decentralization in Health Care” 2007
European Observatory on Health Care System and Policy website
Peer review journals: Health Policy; Health Economics…
In Italy Formez “I sistemi di
governance dei servizi sanitari regionali” 2007
Annual reports: Rapporto OASI Rapporto CEIS Rapporto Sanità –
Fondazione Smith Kline Other Italian healthcare
management journals
Milena Vainieri - Volterra,09 june 2008
The literature review: Health Care Reforms (2)
“FASHION” OF TOPICS IN HEALTH CARE REFORMS:
The evolution of
Regional Health
System
1995 2004 2007
Decentralization and Recentralization
Periodical comparisons among EU countries
Some specific articles on single country reform
IN ITALY…
1992 2000 2007
Focus on LHAs/THs Dimensions
Federalism – Devolution
Risk and Opportunities
How to assess health reforms
2007
1995
Milena Vainieri - Volterra,09 june 2008
The literature review: Performance Evaluation Systems in Health CareAt international level National reports Broad literature that:
Describes experiences; Points out conceptual
framework on performance measurement systems: PATTERNS PROCESSES
At national level Balanced Scorecard in
LHAs/THs Italian regional Health
Care Agency (Agenas) 2008 (few Regions)
Regional experiences and reports
Milena Vainieri - Volterra,09 june 2008
The literature review: The relationships
PERFORMANCE
HEALTH CARE REFORMS
PERFORMANCEEVALUATION
SYSTEMS
Many papers and researches
- Framework
- Assessment
European
Observatory
and Formez
Many papers and researches:
-Focus on Hospital
- Focus on NHS
Some papers and researches:
-Focus on Hospital
- Up to now I haven’t found a paper on the relationship at an upper level
Up to nowI haven’t found a
research that puts togetherThese 3 elements
Milena Vainieri - Volterra,09 june 2008
Looking for closing the gap of relationships
PERFORMANCE
HEALTH CARE REFORMS
PERFORMANCEEVALUATION
SYSTEMS
Many papers and researches
- Framework
- Assessment
European
Observatory
and Formez
Many papers and researches:
-Focus on Hospital
- Focus on NHS
Some papers and researches:
-Focus on Hospital
- Up to now I haven’t found a paper on the relationship at an upper level
Up to nowI haven’t found a
research that puts togetherThese 3 elements
Some papers and researches:
-Focus on Hospital
- Look fot the relationship at an upper level
Put togetherThese 3 elements
Milena Vainieri - Volterra,09 june 2008
Research questions
1. Are there any relationships among Health Care Reforms and Performance Evaluation Systems (P.E.S.) at Regional or National level?
2. The interaction effect of Health Care Reforms and P.E.S. on the Performance
Milena Vainieri - Volterra,09 june 2008
Methodology (1)Preliminary steps To identify and classify the features of the
Performance Evaluation System of OECD Health Systems and Italian Regional Health Systems
To identify and classify the features of Health Care Reforms of OECD countries and Italian Regional Health Systems Literature and reports available Interviews with Regional Italian Councillors and
other Policy makers.
Milena Vainieri - Volterra,09 june 2008
Methodology (2)R.Q. 1
Y = f(Xi)+e
Y: features of P.E.S. Xi: features of Health
Reforms Cross sectional analysis
(regression analysis)
R.Q. 2
Y = aiX1i+bjX2j+ c(X1*X2)+e
Y: Performance X1i: Features of Health
Reforms X2j: Use of P.E.S.
Time series analysis
Preliminary basic statistics Preliminary basic statistics
Milena Vainieri - Volterra,09 june 2008
Possible difficulties
The R.Q. 2 -.
The“use” of P.E.S.
The “features” of P.E.S. The R.Q. 2 –
Difficulty to collect data for time series analysis
qualitative analysis
Milena Vainieri - Volterra,09 june 2008
Timing of the research work
REVIEW OF LITERATURE REGIONAL ITALIAN HEALTH
SYSTEM Interviews with Councillors and
Head of Health Regional Departments
Focus group with CEO of LHAs/THs
National Workshop Selection of OECD HEALTH
SYSTEMS (Ontario -Comunidad Valenciana…) and gathering data
CLASSIFICATION OF FEATURES MODELS TO ANALYZE
RELATIONSHIPS
June-Ago
Sep-Nov
Dec-Feb
Mar-May
June-Ago
Sep-Nov
Dec-Feb
Milena Vainieri - Volterra,09 june 2008
Deliverables
The review of literature and the classification of P.E.S. and Health Care Reforms (Positioning paper)
A cross sectional analysis of the Performance Evaluation System across Italian Regions (December 2008)
The findings of the overall research
…or… Comparing 2-3 case-studies (the Tuscan - Ontario
or Comunidad Valenciana Health Systems)
Milena Vainieri - Volterra,09 june 2008
Comments and suggestions…
…are really welcome.