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RPS 1 2018

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health and care system

Economic Evaluation in Care and Health Services

Articolo scritto da:

Population ageing and technological development in industrialised countries have helped bring to the fore the subject of the efficient allocation of resources in welfare systems. In the health sector, economic evaluation is a tool designed to guide allocation decisions in relation to a crucial dimension of the problem: the opportunity cost. Since the 1960’s a strong increase in the number of studies has been noted particularly in the pharmacological sector, and in many countries the results of these studies have been used to issue specific guidelines. only subscribers can see the full article

Data, or Ambivalence

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Both common sense and methodological reasons should make it obvious that every time we leave a strict «experimental» context, data have extremely and explicitly ambivalent relations with the reality they describe, plan and evaluate: this is part of their role, which is never independent of context, and still less neutral or objective. The data are in the service of a hypothesis (in the best of cases: that means they correspond to an explorative work of research or comparison), or a theory (more frequently: they are a response to a plan that seeks to demonstrate, defend or confirm something that has already been decided). In systems that are more or less rapidly being redefined or evolving, and that are already «dependent» on «other» macro-variables, the potentiality/possibility of profound ambivalence in the data translates almost naturally into concrete and/or planned probability.only subscribers can see the full article

«Cura»

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in the issue
Nhs
In the Italian language one term «cura» is used to express both the complex therapeutic equipment and procedures used to fight the disease (to cure), as well as the wider and more general attention and concern towards the suffering and fragility of others (to take care of). This polysemy conceals the parallel course of which the two dimensions of care have been the protagonists since the origin of scientific medicine, and which is now making a comeback given the emergence of some phenomena culminating in the incurability of the patient. Yet, to avoid the risk of a sterile reductionism or a mere juxtaposition, it is necessary to go back to the most ancient roots of such an antithesis, going back over the history of medicine from its mythological origins to the beginning of clinical medicine.only subscribers can see the full article

Health Societies in the Pisa Area. Characteristics and Process of Territorial Control

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I’ll try and explain what has been done in the last twelve years in Tuscany and Pisa. After reflecting on the question for several years, we were convinced of the importance of making the local administrations fully responsible for the problems of wellbeing and health. The starting-point was the integration between the social and health sectors. Some general considerations on these subjects, now generally known, which led the Municipalities to start this debate, may help us understand the various phases.only subscribers can see the full article

Good Management and Appropriateness of Services

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This contribution is intended to answer two questions: 1) what do we mean by cost-performance, efficiency and efficacy; 2) why do we now talk about appropriateness. We can define these terms as follows: * cost-performance means conforming and responding to principles of economics in the sense of parsimony and saving; * efficiency is the situation of maximum productive capacity, at minimum possible costs, in a combination of production or supply of goods and/or services; * efficacy is the capacity to fully produce the desired effect and the obtaining of it. Nothing can be managed, still less managed well, that is, there can be no administration of the goods and/or interests for others, if the principles of cost-performance, efficiency and efficacy are not borne in mind and applied. only subscribers can see the full article

Editor’s note

Articolo scritto da:

Following a still recent custom, this issue of «Rps» reprints the contributions to the journal’s second annual Forum. It is a discussion that took place in November 2006 on the subject of various aspects of the Italian health-care system, and reprinting it was a complex matter: we did not want a mechanical reproduction of the original talk, but something rethought and rewritten by the speakers as much as possible. Not the least of the complications for this edition was our desire to publish the whole material in English too, convinced as we are that reflection on the social situation in Italy has a vital need of contributions from abroad. only subscribers can see the full article

Betty Leone

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I welcome the decision to devote a session of the seminar on health and welfare policies to issues related to a proper definition of informative system aimed to transferring knowledge among health workers, and from them to the general public, and vice versa. The debate is not new. On the contrary, it characterized the ’70’s and ’80’s in the period of health service reform and it was later taken up again during the discussions that led to the law (no. 328/2000) on welfare reform. Indeed, it is clear that this subject meets various needs. The first is that of identifying the needs to which we are to respond: this is an essential function if the services are not to fall into a merely self-referential logic rather than responding to the need to meet the general public’s requirements effectively. only subscribers can see the full article

The Integration that We Lack, and that We Need

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I want first of all to concentrate on one important aim that has guided Rps in organising this Forum on welfare integration: placing the accent on the concept of «integration» rather than on that of «social-health», understood as a system of services, and this aim is particularly important for me. We can talk about welfare integration in various ways, meaning aspects that are also very different and potentially in conflict with each other. On the one hand, we hear talk of social-health integration as if it were the more or less official name for a sector, a synonym of the social-health sector, that accompanies the health and the care sectors. only subscribers can see the full article

Data Policy in the Social and Health Sector. A Focus on Municipal Expenditure

Articolo scritto da:

Returning to the thoughts in earlier essays on the difficulties for the functioning of the health and social services caused by an ongoing lack of information, this article considers the question of data policy in the welfare sector. This aspect is one of the enabling conditions for integration in both welfare policies and social policy in general, and is the basis for an effective and efficient functioning of the health and social system, understood as all those services and interventions that include care and social integration, treatment, prevention and protection. only subscribers can see the full article

Paolo Ferrero

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First of all I’d like to thank you for your invitation to contribute to this Forum. Various problems seem to have emerged, and I’d like to try and talk about them. Apart from some criticisms relating to questions of organisation, I particularly want to draw attention to a specific problem, that of the essential levels of care, with special reference to the question of non-self-sufficiency. I want to talk about it in cultural as well as political terms, though in this latter sense our policy on this should start to be implemented in the next few months. I start from one element for evaluating the present situation. It seems to me obvious that — and here I agree with the judgments given — the social sector is much less protected in the constitution than the health sector. Traditionally there has always been a strong difference in the level of services in our country.only subscribers can see the full article