Higher Sustainability and Lower Opportunistic Behaviour in Healthcare: A New Framework for Performing Hospital-Based Health Technology Assessment. Sustainability

Innovative health technology deployment represents the primary challenge within the sustainability of public health systems. On one hand, new technologies may potentially improve access to care and the quality of services. On the other hand, their rapid evolution and broad implications on existing procedures increase the risk to adopt technologies that are not value for money. As a consequence, Health Technology Assessment (HTA) is a critical process at each level of the National Health System. Focusing on the organisational level, this paper explores the current practices of Hospital-Based HTA (HB-HTA) in terms of management, control and behaviours of various actors involved. Among several tasks, decision-makers are appointed at managing the conflict of interest around health technology development, that could pave the way for corruption or other misleading behaviours. Accordingly, the purpose of the study is proposing a new strategic framework, named Health Technology Balanced Assessment (HTBA), to foster hospital-based health technology management aimed to align strategy and actions. The conceptual model is developed on three perspectives (clinical, economic and organisational) to make the actors involved in the assessment (clinicians, health professionals, hospital managers and patients) aware of the impact of new technology on the value chain. Besides supporting the decision-making process, such a tool represents support for the internal control system as a whole. By promoting structured evaluation, it increases transparency and accountability of public health organisations. Moreover, in the long run, the framework proposed will be useful to reach selected United Nations Sustainable Development Goals (UN SDGs) to enhance the quality of healthcare in the future

Value-Based Healthcare paradigm for healthcare sustainability

Healthcare represents a paramount issue in the current debate around sustainability. Developing sustainable practices within health systems is fundamen- tal not only to guarantee the right of care, but also to enhance the growth of a country. The widespread dissemination of innovation, on the one hand, could represent a way for providing a better service, in terms of quality and access. On the other hand, it is severely undermining the sustainability of health organisations due to high costs and magnitude on existing organisational arrangements. Among the various research strands aimed to identify theoretical framework to face the various challenges, Value-Based Healthcare is largely considered as the blueprint for promoting sustainable management approaches in healthcare. This paradigm stresses the importance to deliver care towards enhanced value for the patient, which could be measured through the ratio between outcomes and costs. This chapter has a twofold aim. First of all, it is aimed at exploring the concept of Value-Based Healthcare to realise the state-of-art and to identify main issues and open questions around the drivers of value in health. Besides, it attempts to under- stand whether this approach could effectively contribute to the attainment of sus- tainable development goals. To do that, an in-depth explanation of the concepts of outcome and cost in healthcare has been carried out. At the end of the analysis, principles of Value-Based Healthcare seem to be usefulness to cope with the need of improved practices. The focus on the value of patient, instead, allows to foster behaviours that could support the achievement of sustainable goals aimed to provide better and more accessible infrastructures. Within this complex mosaic, accounting could represent the common language to orient health management towards a higher sustainable value for the patient

Budgeting Control System and e-Procurement: an Integrated Tool for Limiting Misconducts in Healthcare Purchasing Procedure

Corruption and misconducts, ―thea buse of entrusted power for private gain‖ (Pope, 2008), are pervasive virus that negatively affects the public lives of many Countries. Given that the 9% of the worldwide GDP on average is represented by health expenditure, healthcare is particularly vulnerable to corruption (Petkov and Cohen, 2016; EU, 2017). Due to the large number of services delivered, Public Hospitals and Local Health Authorities undergo a high risk of misconducts, which could bring not only to a waste of public resources, but also to undermine access to the services, impoverishing their quality and the possibility for sustainable development of countries (Braithwaite, 2013; Neu et al., 2013). Corrupt practices and fraud affect up to 25% of expenditure on medical and non-medical goods (Sorenson and Kanavos, 2011); these increase inequality and determine substantial well-being and value losses (Porter, 2010). Corruption can be expressed by the Klitgaard‘s equation (1998): Monopoly plus Discretion minus Accountability. Hence, to limit corruption phenomena an efficient way seems to be increase accountability and transparency by strengthening of internal controls (Christensen and Skærbæk 2007; Fadda et al, 2017). Accordingly, e-Procurement in the public domain can be seen as a tool to support the delivery of public purchasing process, improving efficiency and transparency of transactions (Carayannis and Popescu, 2005; Croom and Brandon-Jones, 2005); Budgeting control system is a powerful tool to align strategies and plans with operational decisions (Garrison et al, 2010), suitable for simultaneous controls in daily management and purchasing decisions (Provenzali, 1991). Therefore, the goal of this work is to understand if it is possible to integrate the simultaneous budgeting-based control system with the e-Procurement procedures (through an ERP software), and how this integration could potentially limit misconducts in healthcare purchases. After a theoretical background about themes of Corruption, e-Procurement and Budget, a single pilot qualitative case study (Yin, 2014) has been conducted. In particular, we developed a qualitative inquiry (Patton, 2002) based on face to face interviews (Said et. al, 2017) with two high-qualified SAP  developer-providers. This contribution attempts to clarify how internal controls impact on the ―responsibility chain‖ (roles, responsibility, transparency degrees of discretion) of procurement process in public healthcare, by increasing level of accountability. This paper fosters debate about relationship between corruption and level of internal control system of Healthcare Organization. This would have considerable consequence also for practitioners involved in ERP software development

Public Organisations as Sustainable Communities

Public organisations should contribute to value creation moving towards sustainability as a vision for strategy and action, redesigning trust-based relationships with stakeholders and sustaining governance networks within ecosystems. As organisations seeking sustainability, public organisations should evolve as communities developing strategic, managerial and technological sources to enable and facilitate public value creation within society. Public organisations should achieve sustainability and develop the community adopting a logic service view as strategic choice, strengthening transformational and ethical features of public managers as leaders, and developing the potential of information technology by driving the transition from using technology in government to developing digital, smart, lean and open platforms for value creation, innovation and networking as sources that enable public organisations as sustainable communities

Public Organisations as Sustainable Communities

Public organisations should contribute to value creation moving towards sustainability as a vision for strategy and action, redesigning trust-based relationships with stakeholders and sustaining governance networks within ecosystems. As organisations seeking sustainability, public organisations should evolve as communities developing strategic, managerial and technological sources to enable and facilitate public value creation within society. Public organisations should achieve sustainability and develop the community adopting a logic service view as strategic choice, strengthening transformational and ethical features of public managers as leaders, and developing the potential of information technology by driving the transition from using technology in government to developing digital, smart, lean and open platforms for value creation, innovation and networking as sources that enable public organisations as sustainable communities

What Is the Inpatient Cost of Hip Replacement? A Time-Driven Activity Based Costing Pilot Study in an Italian Public Hospital

The emphasis on value-based payment models for primary total hip replacement (THA) results in a greater need for orthopaedic surgeons and hospitals to better understand actual costs and resource use. Time-Driven Activity-Based Costing (TDABC) is an innovative approach to measure expenses more accurately and address cost challenges. It estimates the quantity of time and the cost per unit of time of each resource (e.g., equipment and personnel) used across an episode of care. Our goal is to understand the true cost of a THA using the TDABC in an Italian public hospital and to comprehend how the adoption of this method might enhance the process of providing healthcare from an organizational and financial standpoint. During 2019, the main activities required for total hip replacement surgery, the operators involved, and the intraoperative consumables were identified. A process map was produced to identify the patient’s concrete path during hospitalization and the length of stay was also recorded. The total inpatient cost of THA, net of all indirect costs normally included in a DRG-based reimbursement, was about EUR 6000. The observation of a total of 90 patients identified 2 main expense items: the prosthetic device alone represents 50.4% of the total cost, followed by the hospitalization, which constitutes 41.5%. TDABC has proven to be a precise method for determining the cost of the healthcare delivery process for THA, considering facilities, equipment, and staff employed. The process map made it possible to identify waste and redundancies. Surgeons should be aware that the choice of prosthetic device and that a lack of pre-planning for discharge can exponentially alter the hospital expenditure for a patient undergoing primary THA