Creare Valore Sanitario: nuove prospettive per il management delle aziende sanitarie

The value creation is the primary target of a firm and to this pattern is inspired each managerial instrument, behaviour and action. For particular firms as health companies, the pattern of value creation can be well – grounded, provided that it takes care of their particular attributes. Therefore this article is structured on the following methodology of analysis: first of all the pattern of value creation for private firms is shown making clear the meaning of value creation compared with firm’s strategic targets. Then the particular attributes of health companies and the meaning that value creation can undertake in these circumstances are analysed. If the creation of health value can become the strategic target of a health company, it is essential a valuation of the “key variables” marking out the way to create value. At last the change of classical instruments of management and administration control are described. To create health value is the real strategic target of health companies. After years of prevailing or exclusive orientation to efficiency, now managerial instruments rediscover the efficacy and the quality of medical treatments as “key variables” to program and control. Old management tools, such as the budget or the reporting, can become an excellent support for every operator, first of all the medical class that, because of various motives, was (and is) particularly refractory to these instruments. The pattern of value creation can become the philosophy which has to inspire all the health management instruments, and the common language for all the cultures and the professions inside the health companies. Concluding, the pattern of value creation can be an interesting proposal to innovate control systems of health companies and to put an end to the impasse of most of the health management’s applications, but, it required a new co-operation between managers and medical class. Only if the medical class will accept valuation and measurement systems of activity, the value creation will stop to be just a theory and will become a reality

Una checklist per la gestione dei costi nel trattamento dell’HIV

The human immunodeficiency virus (HIV) infection is currently one of the major health problems in the world. Since the first occurrence of the infection 17 years ago until today, many people have died of its devastating consequences and an enormous amount of health-related funds have been spent on the problem. The pandemic is still growing in some areas, and its negative impact on society is in-creasing. This is the main reason why scientists are trying to find the best way to reduce costs and still keep the same level of management or, in some ways, even improve it (e.g., new combination of drugs in one pill—fewer pills to be taken per day). Since HIV infection has been. a fatal, severe, and widespread disease, a so-called global problem, very early in the course of the pandemic the idea of economic evaluation was raised. Published studies mostly presented the antiretroviral drugs in the frames of pharmacoeconomic models or costs of HIV/AIDS according to development of the disease through longer time periods. The cost sections that have to be considered in any pharmacoeconomic study of HIV management are briefly presented. Often the presented costs are confusing and could be misleading. Direct, indirect, and intangible costs are described

Analisi comparativa del mercato dei dispositivi per incontinenza in cinque paesi europei

The aim of the paper is to compare and valutate the market of the incontinence devices in five European countries: Italy, France, Germany, U.K. and Denmark. We chose incontinence devices because they are strictly connected with the development of the home delivery. France, Germany and U.K. has been analysed for their politic and territorial importance, while Denmark has been considered for its home assistance system. A common pattern has been applied in every country: first of all there is a general outline of the legislative aspect of the incontinence devices, then the study presents prescription procedure and the different models of distribution. Finally, it shows the competitive systems of the pharmaceuticals industry in every single country. The necessary information has been gathered through relevant literature and interviews with the area operators. The incontinence devices are repayable in all the studied countries, except from France. Every country has different health system (Italy, U.K and Denmark had a public health system; France and Germany has a mutualist health system). There isn’t an evident correlation between the type of the health system and the market of the incontinence devices

Creazione di valore sanitario e sistemi di finanziamento: il caso del dipartimento di salute mentale

Health-value adding is the new priority and a watchword for all clinicians and health service workers. The creation of health-value requires a team work involving different actors: A. the clinical staff, whose task consists in the creation of treatment models and in their formalization into guidelines and protocols; B. the managers, since effective clinical and therapeutic practices must go along with coherent organizational models and valuable control instruments; C. the public institutions responsible for the definition of health policy guidelines: among these, a prioritary role is played by funding methods, which can affect significantly the results of health-value adding initiatives. This work aims at studying the relationships between funding methods and health-value creation, with particular reference to mental health services. Particular relevance is given to the funding of mental health departments, with a view to putting aside the shortcomings of the current models and proposing the DRG as an alternative funding method for mental health services. The procedures for patients classification and evaluation envisaged in the psychiatric DRG can assist health service managers in evaluating the outcomes and the patients’ health conditions. In other words, the issues concerning funding and management evaluation will be articulated in the same language: this, in turn, will eliminate the lack of integration which can be presently identified as the main fault of most funding methods, and improve the degree of coherence among resource allocation, activities and results. The case of mental health services can therefore be taken as an example of successful and effective cooperation among management, health policy and clinical staff

Percorsi diagnostico-terapeutici nella gestione dei pazienti affetti da polmonite acquisita in comunità

Community-Acquired Pneumonia (CAP) is one of the major cause of death due to infectious diseases in developed countries. In Italy, about 18% of the patients with CAP are hospitalized, accounting for an annual health-care cost of more than 1.000 billion Lire. Overall, CAP represents an heavy burden to the society and the National Health-Care System. The managed-care of patients with CAP should be committed to find a balance between the individual health-care needs and the more general claims of a fair utilization and an overall efficiency of the healthcare system. The comprehensive strategy of care should consider many decision nodes and the outcomes related with each different options. The diagnostic procedures (physical examination, chest radiography, microbiology, laboratory) should be oriented to obtain a robust differential diagnosis and to estimate the risk of mortality. Prediction rule are now available that help physicians to make more rational decisions about hospitalization for patients with pneumonia. The selection of antibiotic in the absence of an etiologic diagnosis is based on the epidemiological settings, the severity of the illness and other clinical conditions of the patients. Non concordant therapeutic recommendations are provided by the published guidelines. Decisions to be taken during the follow-up concern the switch therapy and the early discharge options, as soon as the patient stabilizes, or the admission to ICU in case of worsening. The length of hospital stay depends on the time to stability and the risk of mortality. However, socio-cultural factors and availability of outpatient care programs could facilitate the early discharge of patients and help to decrease the health-care costs of CAP patients. The results of the present review can be used as a background to implement a general decision model suitable to performe pharmacoeconomic analysis of the CAP therapy

Le analisi costo della malattia e costo efficacia in farmacoeconomia. Ambiti di applicabilità, problemi, prospettive

Aim of the paper is to compare and evaluate some of the main features of two different tecniques of economic analyses: cost of illness e and cost-effectiveness. The former is not so widely used in pharmacoeconomics, while the latter is dominant. Although their theory has recently much progressed, their practice is still hindered by some unresolved questions, to which the paper also addressess