Il capitalismo municipale e le esternalizzazioni fredde

La novella legislativa del 2003 (d.l. 269/2003) ha inciso sull\u2019assetto dei servizi pubblici locali aumentando le fattispecie nelle quali l\u2019ente locale pu\uf2 assumere la veste di soggetto proprietario, attraverso l\u2019acquisizione di partecipazioni in societ\ue0 a capitale totalmente pubblico o a capitale misto pubblico-privato0. Questo scenario istituzionale \ue8 diventato cornice ideale per l\u2019affermazione definitiva del fenomeno del gruppo comunale, che vede il Comune assimilato ad una holding che controlla un sistema di entit\ue0 formalmente indipendenti, strumentale alla realizzazione dei suoi fini sociali e alla promozione dello sviluppo economico e civile delle comunit\ue0 locali. Alla crescita esponenziale del peso dei servizi gestiti dal Comune per il tramite di entit\ue0 partecipate, non \ue8 corrisposta l\u2019evoluzione del suo sistema informativo-contabile verso un modello che dia conto dei risultati, di natura reddituale, patrimoniale e monetaria, ottenuti grazie al complesso delle attivit\ue0 sulle quali estende il suo potere di controllo. Il modello che coglie le interrelazioni operative fra le unit\ue0 del gruppo e la loro complementarit\ue0 rispetto ad un progetto strategico unitario \ue8 il bilancio consolidato. Allorch\ue9 si progetti di adottare il bilancio consolidato nel contesto pubblico locale, ci si imbatte in alcune problematiche da risolvere preventivamente. Merita di riflettere sostanzialmente su tre momenti: a) l\u2019individuazione delle unit\ue0 appartenenti al gruppo comunale (definizione dell\u2019area di gruppo); b) l\u2019individuazione delle unit\ue0 del gruppo comunale i cui bilanci di esercizio dovranno essere consolidati analiticamente (definizione dell\u2019area di consolidamento); c) la ricerca delle condizioni di uniformit\ue0 che devono sussistere perch\ue9 la procedura di consolidamento possa generare valori significativi e attendibili. Gli indubbi vantaggi informativi che si attribuiscono al bilancio consolidato non devono per\uf2 generare l\u2019erronea convinzione che esso debba sostituire i bilanci di esercizio delle unit\ue0 appartenenti al gruppo comunale. In particolare, l\u2019elisione dei valori reciproci, pur rispondendo appieno allo scopo per il quale il bilancio consolidato \ue8 redatto, cela informazioni sull\u2019intensit\ue0 e la direzione delle operazioni infragruppo che potrebbero rivestire molta importanza nell\u2019ottica di determinati soggetti: chi si occupa di problemi della finanza pubblica, ad esempio, \ue8 interessato a conoscere l\u2019importo e la distribuzione dei trasferimenti che il Comune concede agli enti gestori dei servizi pubblici, posto che la scelta dei servizi, e quindi degli enti erogatori, che potranno godere in misura minore o maggiore dei contributi (ad integrazione, ad esempio, di tariffe pi\uf9 o meno remunerative) \ue8 un\u2019informazione importante per valutare la politica di redistribuzione dei redditi attuata dal Comune nell\u2019ambito della collettivit\ue0 amministrata, tenuto conto che i servizi erogati sono destinati a categorie di utenti differenziate, con diversa capacit\ue0 di spesa. Ecco perch\ue9 il bilancio consolidato deve essere correttamente inteso quale porzione di un sistema informativo pi\uf9 vasto, comprendente i bilanci delle singole societ\ue0 del gruppo

Aligning taxation and international financial reporting standards: Evidence from Italian listed companies

We estimate the effect of adopting International Financial Reporting Standards results (IFRS) as the base for the regional business tax (IRAP). Analysing the unconsolidated financial statements of non-financial Italian listed companies, we simulate the change in the IRAP base where companies move from Italian Generally Accepted Accounting Principles (GAAP) to IFRS. The results show that the impact of the use of IFRS for the computation of tax figures is relatively important and that the sector in which companies operate has a decisive influence on the amount by which the taxable base differs. The empirical analysis suggests that the transition increases, on average, the IRAP base of around 15% and that companies in the constructions and utilities sectors suffer an additional burden of around 29% and 31%, respectively. Similarly to Italy, many European Member States are characterized by creditor protection oriented domestic GAAP and by a close link between tax and financial reporting and could therefore experience similar effects due to the use of a IFRS-based tax accounting.We estimate the effect of adopting International Financial Reporting Standards results (IFRS) as the base for the regional business tax (IRAP). Analysing the unconsolidated financial statements of non-financial Italian listed companies, we simulate the change in the IRAP base where companies move from Italian Generally Accepted Accounting Principles (GAAP) to IFRS. The results show that the impact of the use of IFRS for the computation of tax figures is relatively important and that the sector in which companies operate has a decisive influence on the amount by which the taxable base differs. The empirical analysis suggests that the transition increases, on average, the IRAP base of around 15% and that companies in the constructions and utilities sectors suffer an additional burden of around 29% and 31%, respectively. Similarly to Italy, many European Member States are characterized by creditor protection oriented domestic GAAP and by a close link between tax and financial reporting and could therefore experience similar effects due to the use of a IFRS-based tax accounting

Perceptions, attitudes and training needs of primary healthcare professionals in identifying and managing frailty: a qualitative study

PURPOSE: Although frailty can be delayed or prevented by appropriate interventions, these are often not available in countries lacking formal education and infrastructure in geriatrics. The aim of this study was to: (a) explore ideas, perceptions and attitudes of primary health care (PHC) professionals towards frailty in a country where geriatrics is not recognised as a specialty; (b) explore PHC professionals' training needs in frailty; and (c) define components of a frailty educational programme in PHC. METHODS: Qualitative design, using two focus groups with PHC professionals conducted in Thessaloniki, Greece. Focus groups were audio recorded and transcribed. Data were analysed with thematic analysis. RESULTS: In total 31 PHC professionals (mean age: 46 years; gender distribution: 27 females, 4 males) participated in the study (physicians n = 17; nurses n = 12; health visitors n = 2). Four main themes were identified: (1) Perceptions and understanding of frailty; (2) Facilitators and barriers to frailty identification and management; (3) Motivation to participate in a frailty training programme; (4) Education and training. The main barriers for the identification and management of frailty were associated with the healthcare system, including duration of appointments, a focus on prescribing, and problems with staffing of allied health professionals, but also a lack of education. Training opportunities were scarce and entirely based on personal incentive. Professionals were receptive to training either face-to-face or online. A focus on learning practical skills was key. CONCLUSION: Education and training of professionals and interdisciplinary collaboration are essential and much needed for the delivery of person-centred care for people with frailty living in the community

Feasibility and impact of a short training course on frailty destined for primary health care professionals

BACKGROUND: There is an unmet need for training primary health care professionals on frailty, especially in countries where geriatrics is still emerging. PURPOSE: We aimed to evaluate the feasibility and efficacy of a training course for primary health care professionals on the detection, assessment, and management of frailty. METHODS: A single-day training course, developed and facilitated by three physicians trained in geriatrics abroad, was organized by the Aristotle University of Thessaloniki Primary Hearth Care Research Network. Primary health care professionals' attitudes, knowledge, and everyday practices regarding frailty were assessed by self-administered anonymous questionnaires (using Likert-type scales) at three time-points (before, upon completion of the training course, and 3 months afterward). RESULTS: Out of 31 participants (17 physicians, 12 nurses, 2 health visitors; 87.1% women; mean age 46.4 years), 31(100%) filled in the first, 30(97%) the second, and 25(81%) the third questionnaire. Improvements were reported in familiarization with the frailty syndrome (p = 0.041) and in self-perception of knowledge and skills to detect (p < 0.001) and manage (p < 0.001) frailty, that were also sustained 3 months afterward (p = 0.001 and p = 0.003 respectively). Improvement was also observed in the attitude that frailty is an inevitable consequence of aging (p = 0.007) and in the frequency of application of screening (but not management) strategies, 3 months following the workshop compared to baseline (p = 0.014). Participants reported less disagreement with the statement that systematic screening for frailty was unfeasible in their daily practice at 3 months compared to baseline (p = 0.006), mainly due to time restrictions. CONCLUSION: A short skill-oriented training course can significantly and sustainably improve primary health care professionals' attitudes and practices regarding frailty

Effectiveness of the innovative 1,7-malaria reactive community-based testing and response (1, 7-mRCTR) approach on malaria burden reduction in Southeastern Tanzania

In 2015, a China-UK-Tanzania tripartite pilot project was implemented in southeastern Tanzania to explore a new model for reducing malaria burden and possibly scaling-out the approach into other malaria-endemic countries. The 1,7-malaria Reactive Community-based Testing and Response (1,7-mRCTR) which is a locally-tailored approach for reporting febrile malaria cases in endemic villages was developed to stop transmission and Plasmodium life-cycle. The (1,7-mRCTR) utilizes existing health facility data and locally trained community health workers to conduct community-level testing and treatment.; The pilot project was implemented from September 2015 to June 2018 in Rufiji District, southern Tanzania. The study took place in four wards, two with low incidence and two with a higher incidence. One ward of each type was selected for each of the control and intervention arms. The control wards implemented the existing Ministry of Health programmes. The 1,7-mRCTR activities implemented in the intervention arm included community testing and treatment of malaria infection. Malaria case-to-suspect ratios at health facilities (HF) were aggregated by villages, weekly to identify the village with the highest ratio. Community-based mobile test stations (cMTS) were used for conducting mass testing and treatment. Baseline (pre) and endline (post) household surveys were done in the control and intervention wards to assess the change in malaria prevalence measured by the interaction term of 'time' (post vs pre) and arm in a logistic model. A secondary analysis also studied the malaria incidence reported at the HFs during the intervention.; Overall the 85 rounds of 1,7-mRCTR conducted in the intervention wards significantly reduced the odds of malaria infection by 66% (adjusted OR 0.34, 95% CI 0.26,0.44, p < 0001) beyond the effect of the standard programmes. Malaria prevalence in the intervention wards declined by 81% (from 26% (95% CI 23.7, 7.8), at baseline to 4.9% (95% CI 4.0, 5.9) at endline). In villages receiving the 1,7-mRCTR, the short-term case ratio decreased by over 15.7% (95% CI - 33, 6) compared to baseline.; The 1,7-mRCTR approach significantly reduced the malaria burden in the areas of high transmission in rural southern Tanzania. This locally tailored approach could accelerate malaria control and elimination efforts. The results provide the impetus for further evaluation of the effectiveness and scaling up of this approach in other high malaria burden countries in Africa, including Tanzania

Payments and quality of care in private for-profit and public hospitals in Greece

<p>Abstract</p> <p>Background</p> <p>Empirical evidence on how ownership type affects the quality and cost of medical care is growing, and debate on these topics is ongoing. Despite the fact that the private sector is a major provider of hospital services in Greece, little comparative information on private versus public sector hospitals is available. The aim of the present study was to describe and compare the operation and performance of private for-profit (PFP) and public hospitals in Greece, focusing on differences in nurse staffing rates, average lengths of stay (ALoS), and Social Health Insurance (SHI) payments for hospital care per patient discharged.</p> <p>Methods</p> <p>Five different datasets were prepared and analyzed, two of which were derived from information provided by the National Statistical Service (NSS) of Greece and the other three from data held by the three largest SHI schemes in the country. All data referred to the 3-year period from 2001 to 2003.</p> <p>Results</p> <p>PFP hospitals in Greece are smaller than public hospitals, with lower patient occupancy, and have lower staffing rates of all types of nurses and highly qualified nurses compared with public hospitals. Calculation of ALoS using NSS data yielded mixed results, whereas calculations of ALoS and SHI payments using SHI data gave results clearly favoring the public hospital sector in terms of cost-efficiency; in all years examined, over all specialties and all SHI schemes included in our study, unweighted ALoS and SHI payments for hospital care per discharge were higher for PFP facilities.</p> <p>Conclusions</p> <p>In a mixed healthcare system, such as that in Greece, significant performance differences were observed between PFP and public hospitals. Close monitoring of healthcare provision by hospital ownership type will be essential to permit evidence-based decisions on the future of the public/private mix in terms of healthcare provision.</p