Ten years since the promulgation of the decree which introduced one of the most discussed and complex reforms in the last decade, the paper offers an assessment of the effects of the introduction of the system of the prospected payment of hospitals based on the Drg, stimulating a reflection on its efficacy as well as on the possibilities of its successive developments. On the whole, there have been positive results with a significant improvement in the technical-organisational efficiency of hospitals and the containment of the upward trend in hospital spending. However some critical factors have emerged: on the one hand, the persistent delay in the updating of the codification and tariff system, and on the other hand, the potential risks to the quality of services and, in particular, the risk that cost control may supersede the need to guarantee an adequate level of service quality.only subscribers can see the full article

The heavy burden of health spending on elderly care is common-place in the preoccupations of policy makers and politicians, and is constantly the focus of media attention. The attention on this subject is however rather ambivalent: stress is not placed on the «physiology» of growth in investments for a part of society that «obviously» expresses several needs and is entitled to corresponding rights; the objective complexity of the problem is presented in such a way as to make the solutions appear increasingly more difficult and not due, with the consequent rise in cultural, political and cognitive marginalisation. Analysing four model scenarios, operative solutions, feasible through a participatory way, are indicated at both the local and general levels.only subscribers can see the full article

During the 90s, the managed competition model, or quasi-market, was the main reference for the reform of European health systems. The concrete application of this organisational model - aimed at reallocating incentives between financiers, producers and users to guarantee the appropriateness of services, the costs containment and the efficient allocation of resources - has occurred even with numerous variants from the starting proposal and through reforms that followed one another discontinuously, at times emphasising and at other times undermining the pro-competition objectives. In this perspective, the paper proposes an analysis of the reforms experienced over the past few years in England and Italy and investigates the reasons that encouraged these countries to progressively reduce the role of competition, preferring negotiated schemes that were considered to be more compatible with solidarity principles that characterized European public health systems.only subscribers can see the full article