PFIs Involving Multiple Public Partners:A Case Study from the Italian Health Care Sector

The financial crisis experienced by many countries since 2008 has given new importance to private finance initiatives (PFIs) for providing public services. This paper analyses the relationships between multiple public and private sector actors participating in a PFI in the healthcare sector in order to better understand the motives and behaviour of public and private sector partners. High levels of trust and the active participation of a regulatory body were found to be significant factors in terms of creating a partnership that benefits all sides

Β-blockers treatment of cardiac surgery patients enhances isolation and improves phenotype of cardiosphere-derived cells

Β-blockers (BB) are a primary treatment for chronic heart disease (CHD), resulting in prognostic and symptomatic benefits. Cardiac cell therapy represents a promising regenerative treatment and, for autologous cell therapy, the patients clinical history may correlate with the biology of resident progenitors and the quality of the final cell product. This study aimed at uncovering correlations between clinical records of biopsy-donor CHD patients undergoing cardiac surgery and the corresponding yield and phenotype of cardiospheres (CSs) and CS-derived cells (CDCs), which are a clinically relevant population for cell therapy, containing progenitors. We describe a statistically significant association between BB therapy and improved CSs yield and CDCs phenotype. We show that BB-CDCs have a reduced fibrotic-like CD90 + subpopulation, with reduced expression of collagen-I and increased expression of cardiac genes, compared to CDCs from non-BB donors. Moreover BB-CDCs had a distinctive microRNA expression profile, consistent with reduced fibrotic features (miR-21, miR-29a/b/c downregulation), and enhanced regenerative potential (miR-1, miR-133, miR-101 upregulation) compared to non-BB. In vitro adrenergic pharmacological treatments confirmed cytoprotective and anti-fibrotic effects of β1-blocker on CDCs. This study shows anti-fibrotic and pro-commitment effects of BB treatment on endogenous cardiac reparative cells, and suggests adjuvant roles of β-blockers in cell therapy applications

Bridging aortic valve surgery to 21st century. what can a surgeon do

Aortic valve stenosis is the most clinically relevant valvular heart disease in the elderlies. Surgical aortic valve replacement (SAVR) represented, for decades, the standard of care for the treatment of severe aortic stenosis. Although SAVR still represents a valid option in this clinical scenario, transcatheter aortic valve implantation proved to be superior to medical therapy and comparable to SAVR in several randomized trials in patients at high or intermediate operative risk. At the same time, the growing aging population carrying on greater morbidities and high risk profiles has led to the development of minimally invasive technologies, as rapid deployment aortic valve replacement or Sutureless, to minimize surgical impact on patients. The Heart Team is nowadays tasked to determine the best option tailored for each patient considering patient-related factors and mastering all the surgical options in terms of both different techniques and types of available valves. Nevertheless, some open issues need to be already answered as: which has the longest durability, which the lower complication rate and the lower overall mortality. The aim of this review is to briefly resume the main features of these different options and explore what kind of open questions these newer-generation prosthetic valves and delivery devices carry

The functioning of co-opetition in the health-care sector: An explorative analysis

The doctrine on the management of the health-care sector has mainly considered cooperation and competition to be opposite models. However, several recent studies of the private sector have stressed the positive effects of balancing competitive and cooperative stimuli in inter-firm relationships. Since many public health-care sectors are often characterized by the presence of both cooperative and competitive forces, this explorative analysis is aimed at identifying the possible determinants of these stimuli and analyzing the likely results of the interaction between these forces within a network of health-care trusts. A better understanding of how simultaneous cooperation and competition impact one another could help regulatory bodies to avoid implementing policies that could produce inconsistent results.Co-opetition Health-care trust networks Italian health-care service

La misurazione degli effetti gestionali nella dottrina economico aziendale italiana

Dottorato di ricerca in economia aziendale. 10. ciclo. Tutore Giuseppe Catturi. Coordinatore Giovanni PadroniConsiglio Nazionale delle Ricerche - Biblioteca Centrale - P.le Aldo Moro, 7, Rome; Biblioteca Nazionale Centrale - P.za Cavalleggeri, 1, Florence / CNR - Consiglio Nazionale delle RichercheSIGLEITItal

4. The functioning of co-opetition in the health-care sector: an explorative analysis

The doctrine on the management of the health-care sector has mainly considered cooperation and competition to be opposite models. However, several recent studies of the private sector have stressed the positive effects of balancing competitive and cooperative stimuli in inter-firm elationships. Since many public health-care sectors are often characterized by the presence of both cooperative and competitive forces, this explorative analysis is aimed at identifying the possible determinants of these stimuli and analyzing the likely results of the interaction between these forces within a network of health-care trusts. A better understanding of how simultaneous cooperation and competition impact one another could help regulatory bodies to avoid implementing policies that could produce inconsistent results

The difficulties presented by cost comparison for health care trusts: an empirical analysis

The aim of this article is to contribute to the debate currently surrounding the question of cost comparison among public health care trusts by presenting an empirical case study of the application of this practice in the Tuscan Health Care Service (THCS). The experience observed in Tuscany will be used to investigate certain aspects of this subject that have been analysed in existing literature. Special attention will be dedicated to the use of cost comparison by health care trusts and the difficulties this practice presents. By adopting a prescriptive approach, on the basis of the outcome of the empirical case study and considerations on benchmarking in public administration presented in existing literature, certain strategies will be recognized as increasing the usefulness of cost comparisons among health care trusts. Adopting these strategies could help to create the conditions in order that data could be considered reliable and used for comparative purposes

Technologies of government in public sector's networks::In search of cooperation through management control innovations

In recent years, the public sector has been the subject of a thorough reassessment in a significant number of countries. During this process of modernization, issues such as interorganizational collaboration and managerial innovation have been progressively placed at the forefront of practice and research. In particular, a number of countries have recently re-organized their public sectors around more or less formalized networks or hybrid inter-organizational forms, which are often led by a regulatory body and governed by a cooperation agreement. The literature on inter-organizational relationships in the public sector has evolved alongside the development of such cooperation agreements and innovative forms of organizing. Nevertheless, despite the fact that networks formed by public organizations, not-for-profit organizations, and private firms provide important services to their relevant communities, limited attention has been dedicated to studying the role of management control practices within inter-organizational relationships in public organizations. This is an important gap in the existing literature that this Special Issue intends to address. For this reason, and most importantly because public sector forms of interorganizational collaborations are likely to differ significantly from those observed in the private sector, in the first part of this Editorial we draw attention to some of the themes that characterize the management and control of inter-organizational relations in the domain of public administration. Next, we introduce the six papers which comprise this Special Issue, and we briefly illustrate how each of them enhances our understanding of the role of control systems within public sector networks. Building on the empirical evidence and theoretical arguments offered by these studies, and after a brief review on the possible alternative ways of conceptualizing the process of adopting new management practices, we point to the further research that needs to be done if we are to understand the role that management control practices play in public sector networks. In particular, we suggest that there is a need to look inside management control practices, to explore what these practices are and, how and why they enable the cooperative “ideal” to become real, as well as to stimulate or hinder opportunities for public sector managerial innovation. It is concluded that there are a number of issues yet to be explored if we are to deepen our understanding of the formal and informal mechanisms of control which are the active elements of the so-called “regulatory hybrids” in the public sector