Managing the italian healthcare system: the viewpoint of the purchasing and marketing office
| Pages | 176-191 |
| DOI | https://doi.org/10.1108/JOPP-03-02-2003-B002 |
| Published date | 01 March 2003 |
| Date | 01 March 2003 |
| Author | Emidia Vagnoni |
| Subject Matter | Public policy & environmental management,Politics,Public adminstration & management,Government,Economics,Public Finance/economics,Texation/public revenue |
VAGNONI
JOURNAL OF PUBLIC PROCUREMENT, VOLUME 3, ISSUE 2, 176-191 2003
MANAGING THE ITALIAN HEALTHCARE SYSTEM: THE
VIEWPOINT OF THE PURCHASING AND MARKETING OFFICE
Emidia Vagnoni*
ABSTRACT. Beginning in the early 1990s, reform of the Italian Healthcare
Service (NHS) led to a controlled competition system. Consequently, managers
had to face a new institutional framework, one which was characterized by the
following elements: citizens’ choice of the healthcare organizations to deliver
the services they need; the integration of public healthcare organizations’ supply
with private accredited organizations; the distinction between producing and
purchasing organizations. Consequently, management of the purchasing and
marketing functions can have a key role in the new situation. By presenting an
analysis of national, regional, and local regulations and case analysis, this paper
points out the main aspects concerning procurement policy in the Italian NHS.
The implications for the internal market mechanism, the Purchasing and
Marketing office’s role, and the activities implemented in order to contribute to
a wide range of decisions are considered.
INTRODUCTION
As in other European countries Italy’s reform of the National
Healthcare System (NHS) started at the beginning of the1990s in order to
make the public system more flexible and able to solve the many
problems related to healthcare demands and to comply with the budget
cap (Abernethy and Brownell, 1999). A higher level of responsibility
was given to the healthcare organizations, making them accountable to
the community for resources consumed. Thus, a public legal status was
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* Emidia Vagnoni, Ph.D., is Associate Professor, Department of Economics and
Accounting Studies, University of Ferrara. She is also the Director of the Master
program in Health Economics and Management. Her research interest is in
healthcare organizations’ management control systems and in public sector
accounting.
Copyright © 2003 by PrAcademics Press
MANAGING THE ITALIAN HEALTHCARE SYSTEM 177
assigned to the Local Health Authorities (LHAs) and to the public
independent hospitals in order to extend the level of responsibility and
autonomy related to administrative, financial, patrimonial, qualitative
and accounting issues.
The new reform law established (a) which healthcare organizations
would produce and deliver healthcare services and (b) which would
purchase healthcare. The new law was designed to improve efficiency
and create conditions for competition. In a competitive environment,
transparence of managerial process and of information is fundamental.
Consequently, LHAs are required to assure a minimal and uniform
standard of medical care with the primary purpose to improve the health
protection of citizens (Law Decree No. 502/1992, article 1). LHAs
deliver healthcare services both directly and by buying them from
accredited public and private health care organizations (art. 8 – Law
Decree n° 502/1992).1
Therefore, the relationships set up between the LHAs and the
healthcare organizations producing care services are a particular
innovation drawn by the reform law. Contracts can be agreed upon by
accredited organizations. In order to manage the above-mentioned
relationships and the related market forces, the development of a special
administrative service, a purchasing and marketing office, has been
required. The Purchasing and Marketing Office’s task is to efficiently
and effectively analyze the level of healthcare services management.
Given this evolution of the healthcare system, purchasing and
strategic marketing principles take on a relevant role, since their related
actions are devoted to improving the resources allocation and the quality
and efficiency dimensions of services. In addition to shedding light on
the quasi-market principles and the objectives of the NHS reform
(Zamagni, 1998), this paper aims to analyze the changes that could affect
LHAs and public independent hospitals, particularly from the point of
view of purchasing and marketing activities. The paper builds on the
results of the contracts and healthcare services literature, and examines
the strategic relationship between a health purchaser and providers under
conditions of controlled competition, as established by the reform law
(Culyer & Jonsson, 1986; Longo, 1997). Thanks to the empirical support
received by the Modena LHA, it is possible to detail the objectives of the
new organizational entity, to explain the kind of relationships to manage
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