1. The impact of health care reforms on the performance evaluation systems State of art – PhD project PhD Student: Milena Vainieri Tutors: Prof.ssa Sabina Nuti Prof. Lino Cinquini PhD in Management, Competitiveness and Development

2. 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

3. 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”

4. Milena Vainieri - Volterra,09 june 2008 The case study: Tuscan Health System REGION CONTROLLERS LHAs/THs CFO ESTAVs MeS Lab AREA VASTA S.E. REGION CONTROLLERS LHAs/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 CONTROLLERS LHAs/THs CFO ESTAVs MeS Lab AREA VASTA N.W. ACTION – RESEARCH APPROACH

5. Milena Vainieri - Volterra,09 june 2008 The case study: the outputs REGION CONTROLLERS LHAs/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

6. Milena Vainieri - Volterra,09 june 2008 The case study: the outputs REGION CONTROLLERS LHAs/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

7. Milena Vainieri - Volterra,09 june 2008 The case study: the outputs The case study of the Area Vasta network in Tuscany Region Findings  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.

8. Milena Vainieri - Volterra,09 june 2008 The case study: the outputs The 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

9. Milena Vainieri - Volterra,09 june 2008 The blind alley PERFORMANCE EVALUATION OF ESTAV…? … NEW PROJECT OF THE MES LAB… Map and compare the Performance Evaluation Systems across Italian Regional Health Services

10. 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 System Health reforms

11. 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

12. Milena Vainieri - Volterra,09 june 2008 The renewal of PhD research project … PERFORMANCE HEALTH CARE REFORMS PERFORMANCE EVALUATION SYSTEMS - Across some OECD Health Systems - Across Italian Regions

13. Milena Vainieri - Volterra,09 june 2008 The literature review HEALTH CARE REFORMS PERFORMANCE EVALUATION SYSTEMS RELATIONSHIPS AMONG PERFORMANCE – HEALTH REFORMS – PERFORMANCE EVALUATION SYSTEMS

14. 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

15. 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… 199220002007 Focus on LHAs/THs Dimensions Federalism – Devolution Risk and Opportunities How to assess health reforms 2007 1995

16. Milena Vainieri - Volterra,09 june 2008 The literature review: Performance Evaluation Systems in Health Care At 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

17. Milena Vainieri - Volterra,09 june 2008 The literature review: The relationships PERFORMANCE HEALTH CARE REFORMS PERFORMANCE EVALUATION 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 now I haven’t found a research that puts together These 3 elements

18. Milena Vainieri - Volterra,09 june 2008 Looking for closing the gap of relationships PERFORMANCE HEALTH CARE REFORMS PERFORMANCE EVALUATION 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 now I haven’t found a research that puts together These 3 elements Some papers and researches: -Focus on Hospital - Look fot the relationship at an upper level Put together These 3 elements

19. 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

20. 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.

21. Milena Vainieri - Volterra,09 june 2008 Methodology (2) R.Q. 1 Y = f(X i )+e Y: features of P.E.S. X i : features of Health Reforms  Cross sectional analysis (regression analysis) R.Q. 2 Y = a i X 1i +b j X 2j + c(X 1 *X 2 )+e Y: Performance X 1i : Features of Health Reforms X 2j : Use of P.E.S.  Time series analysis Preliminary basic statistics

22. 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

23. 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

24. 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)

25. Milena Vainieri - Volterra,09 june 2008 Comments and suggestions… …are really welcome.