The Costs and Benefits of Euro-sation in Central-Eastern Europe Before or Instead of EMU Membership

Countries unable or unwilling to join a Monetary Union can partly replicate membership effects through either a Currency Board or formal replacement of the domestic currency by the currency of the Union. Schemes of this kind have been introduced recently in Transition Economies. The net balance of costs and benefits involved, for the country and the common currency area, are shown to be an empirical question, depending on a number of conditions and primarily on the degree of monetary, real, and institutional convergence already achieved beforehand. Positive net advantages may derive from dollar/Euro-isation but should not be taken for granted.http://deepblue.lib.umich.edu/bitstream/2027.42/39724/3/wp340.pd

The Costs and Benefits of Euro-sation in Central-Eastern Europe Before or Instead of EMU Membership

Countries unable or unwilling to join a Monetary Union can partly replicate membership effects through either a Currency Board or formal replacement of the domestic currency by the currency of the Union. Schemes of this kind have been introduced recently in Transition Economies. The net balance of costs and benefits involved, for the country and the common currency area, are shown to be an empirical question, depending on a number of conditions and primarily on the degree of monetary, real, and institutional convergence already achieved beforehand. Positive net advantages may derive from dollar/Euro-isation but should not be taken for granted.Euro, monetary union, dollarisation, exchange rate regimes, convergence, transition

Can equity be included in a performance evaluation system? Some evidences from the tuscan health care system

Objectives. Can Equity be included in a performance evaluation system? In Italy, the Tuscan Region has tested and now is adopting an integrated model for performance measurement to which the regional administration, the local health authorities, and other stakeholders may refer either in terms of indicators and shared responsibilities. Thoughout this performance evaluation system it is now possible to measure also the capacity to persue equity at a regional and local level. Methods. In 2005 aspects as equity and access to services, that, in a public system, are very relevant and characterize the political strategy, were included in the performance evaluation system to evaluate the action carried out by the local health authorities, i.e. the operative actors of the system. This was achieved identifing equity measures and including them in an essential number of indicators, classified in six dimensions and represented in diagram targets. Results. This comprehensive performance evaluation system helped managers and the regional healthcare system as a whole to learn and to consider equity not only as a political issue but as a management goal. Conclusions. This system, used continuously and systematically at a regional level, is now a public policy tool and supports the Local Health Authorities in keeping equity in their management goals.Performance, Evaluation, Balanced Scorecard, Equity, Health Service Access, Health Targets.

An Open Source architecture to collect and analyze performance measurement data to local health authorities in the Tuscany Region

The aim of this article is to present a hardware and software architecture that shows how to combine different open source technologies in order to realize an efficient system to collect and analyze data from a web survey. The framework presented has been used, in the context of the Performance Evaluation System, to measure the level of satisfaction of the employees of the Tuscany Health Authorities, compared with some specific variables in the internal organizational climate. Using that framework, about 42,000 employees were given the opportunity to fill in a web questionnaire. The survey has collected 20,294 cases.web survey, local health authorities, performance evaluation system

Using patient-reported measures to drive change in healthcare: the experience of the digital, continuous and systematic PREMs observatory in Italy

BACKGROUND: The use of Patient Reported Experience Measures (PREMs) has great potential in healthcare service improvement, but a limited use. This paper presents an empirical case of PREMs innovation in Italy, to foster patient data use up to the ward level, by keeping strengths and addressing weaknesses of previous PREMs survey experiences. The paper reports key lessons learned in this ongoing experience of action research, directly involving practitioners. METHODS: The aim of this paper is to present the results of an ongoing action research, encompassing the innovation of PREMs collection, reporting and use, currently adopted by 21 hospitals of two Italian regions. The continuous and systematic PREMs collection has been implemented between 2017 and 2019 and includes: a continuous web-based administration, using web-services; an augmented and positive questionnaire matching standard closed-ended questions with narrative sections; the inclusion and benchmarking of patient data within a shared performance evaluation system; public disclosure of aggregated anonymized data; a multi-level and real-time web-platform for reporting PREMs to professionals. The action research was carried out with practitioners in a real-life and complex context. The authors used multiple data sources and methods: observations, feedback of practitioners, collected during several workshops and meetings, and analysis of preliminary data on the survey implementation. RESULTS: A continuous and systematic PREMs observatory was developed and adopted in two Italian regions. PREMs participation and response rates tend to increase over time, reaching stable percentages after the first months. Narrative feedback provide a 'positive narration' of episodes and behaviours that made the difference to patients and can inform quality improvement actions. Real-time reporting of quantitative and qualitative data is enabling a gratifying process of service improvement and people management at all the hospitals' levels. CONCLUSIONS: The PREMs presented in this paper has been recognized by healthcare professionals and managers as a strategic and positive tool for improving an actual use of PREMs at system and ward levels, by measuring and highlighting positive deviances, such as compassionate behaviours

Managing gaming phenomena in the Tuscan performance evaluation system.

The problem of gaming in performance evaluation systems is a known phenomenon (Bevan, 2006, Bevan Hood, 2006) that can take place especially when there are economic incentives related to specific targets. In all Tuscan Local Health Authorities (LHAs) and Teaching Hospitals (THs) a multidimensional performance evaluation system has been adopted since 2005, based on administrative and non-administrative data benchmarking. The goal of the Tuscany performance measurement system is to give a general outline for the management of the LHAs and THs, both for evaluating performance and for enhancing and promoting the results of the healthcare system. The performance evaluation system consists of 130 indicators classified in six dimensions: Population health assessment; Regional health system; Quality; Patient satisfaction; Staff satisfaction; Efficiency and financial performance After three years of the performance evaluation system’s adoption, integrated with an incentive system, improvements were achieved in most of the indicators monitored. The paper reports the effects of the performance evaluation system and how gaming phenomena were managed with a special focus on data manipulation. Methods The research team focused the analysis on the larger performance improvements during the years 2005-2007 to evaluate whether gaming phenomena have been taking place. The findings of this analysis were reported and discussed with top managers and professionals through individual interviews and group meetings in order to detect the determinants of the results obtained. In 2007 LHAs and THs whose indicators clearly show large improvement were highlighted during meetings with the top management asking them how his/her organization reaches its results. Results Gaming has been found in indicators concerning small and specific areas, such as the rate of hospitalization for heart failure, while indicators that concern larger phenomena, such as the pre-surgical length of stay, were less involved. The request of evidence to explain the improvement obtained has been a deterrent to gaming behaviors. Conclusions The results suggest that further development is needed to analyse suspicious cases. The public presentation of data and the request for evidence to explain large improvements in peer review meetings ease the accountability process. In addition these can be a deterrent for future activities.Gaming phenomena, Health service improvement, reputational level

Evaluating Performance in the Tuscan Health Care System.

The Tuscan health care system strives to foster cooperation among the various organizations that provide services. Government authorities therefore believe it is important to plan and develop a transparent system capable of monitoring the economic results of the region’s 16 public health authorities and their ability to pursue and accomplish the aims of the regional health care plan. The principal aim of the Tuscan performance evaluation system is to give a general outline of the management of the region’s health care authorities. This outline is intended to be useful both for evaluating performance and for enhancing and promoting the results of the healthcare system.Performance evaluation system, benchmarking in healthcare.

How to re-allocate resources within services through data benchmarking: some evidence from the Tuscan Health System.

Background Tuscany Region has implemented a multidimensional system to assess the performance of all Local Health Authorities (LHAs), based on over 130 indicators classified in 6 dimensions in benchmarking. A study was carried out to use the results of the evaluation performance system to support health system decision makers to cope with resources scarcity. Objective To quantify the amount of resources LHAs can re-allocate, taking actions in different sectors, for services with more value for patients. Methods The analysis was based on the data benchmarking of all the indicators of the performance evaluation system with an impact on the level of resources used. For each indicator, the first step was to estimate the gap between the performance of each LHA and the best performance or the regional average. The second step was to measure this gap in terms of financial value. Results The results of the analysis put on evidence that at the regional level 6 to 10 percent of the budget for healthcare (6.100 ml Euros) can be re-allocated if all the institutions achieve the regional average or the best practice. Some LHAs are already efficient but others have large room for improvement: some of them, working on efficiency and appropriatness, can re-allocate up to the 13% of their total costs in services with more value for patients. Policy Implications The implications of this study can be extremely useful for policy makers and the top management of LHAs in a public system that bases its action on cooperation more that competition. Benchmarking makes the system capable to measure the financial impact of different types of actions which can effect efficiency.Disinvestment, setting priorities, healthcare

Fiducia dei cittadini e valutazione della performance nella sanità italiana - Una sfida aperta

Collana “Creare un valore nella sanità pubblica