The Regionalization of the Public Health System and New Governance Models for Healthcare: The Stroke Network Case in Italy

• Published date: 01 June 2011
• Author: Guido M. Signorino,Domenica Farinella,Pietro Saitta
• Date: 01 June 2011
• DOI: http://doi.org/10.2202/1948-4682.1139

Volume 3, Issue 2 • 2011 • Article 6

The Regionalization of the Public Health System and New

Governance Models for Healthcare: The Stroke Network Case

in Italy

Domenica Farinella, University of Messina

Pietro Saitta, University of Messina

Guido M. Signorino, University of Messina

Farinella, Domenica; Saitta, Pietro; and Signorino, Guido M. (2011) "The Regionalization of the

Public Health System and New Governance Models for Healthcare: The Stroke Network Case in

Italy," World Medical & Health Policy: Vol. 3: Iss. 2, Article 6.

http://www.psocommons.org/wmhp/vol3/iss2/art6

DOI: 10.2202/1948-4682.1139

©2011 Policy Studies Organization

The Regionalization of the Public Health

System and New Governance Models for

Healthcare: The Stroke Network Case in Italy

Domenica Farinella, University of Messina

Pietro Saitta, University of Messina

Guido M. Signorino, University of Messina

Abstract

Background: In the 1990s, Italy enacted a drastic reform of the public administration system,

giving local governments (regions) unprecedented autonomy in public service management,

including healthcare. This shift in responsibilities resulted in a lack of consistency in budget

performance and quality of medical care in the regional health systems.

Purpose: This article describes the outcomes of a 2009 study into the reasons for the regional

differences in implementation of “stroke networks” in Italy. Strokes represent one of the most

important health issues for Italy. They are the primary causes of permanent disability, the second

highest cause of dementia, and (in Italy) the third highest cause of mortality. Evidence shows that

early diagnosis and delivery of treatment in specialized stroke units, including rehabilitation

therapy, can reduce the risks of death and disability. Nevertheless, there are significant differences

and delays in the implementation of such practices. To understand the reasons for the delays,

measures were examined, including decision makers’ agendas, regional budget limitations,

organizational delays, structural complexity, competition over scarce resources, power structure

differences, and informal practices.

Methods: The study consisted of 52 in-depth interviews and six focus groups involving 62

people (total = 114 interviewees) and addressing key actors in the health systems from six Italian

regions. In accordance with Italian regulations and research practices, the present sociological

study did not require the approval by an Ethical Committee, since it did not involve minors or

subjects who might be injured, coerced, or those who necessitate an informed consent.

Results: This study outlines five main models of management and shows how competition

with private hospitals, internal rivalries involving professionals and medical sectors, expenditure

restraints, and a lack of well-trained personnel represent the main obstacles to the development

and operation of stroke units.

Policy Implications: Network implementation should be framed within the culture and

standards of the broader social and health context. Social networks should be central to the system

of care, targeting long-term health issues associated with strokes. There is also a need to decrease

competition and increase collaboration among the stakeholders. Finally, the relation between

hospitals, care services, and regional administrations requires improvement.