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N. 122 (2022)

Il contributo del management alla definizione della strategia di decentramento del Servizio Sanitario: il caso del Servizio Sanitario Tunisino

DOI
https://doi.org/10.3280/mesa2022-122oa14619
Inviata
settembre 19, 2022
Pubblicato
2022-12-15

Abstract

Il decentramento in ambito sanitario è da tempo considerato uno dei principali strumenti per far progredire i
sistemi sanitari e per rispondere alle esigenze di equità di accesso alle cure.
La dottrina ha identificato in questo trasferimento del potere decisionale “da pochi a molti” il presupposto della
valorizzazione del ruolo del management, in questo caso, massimamente responsabilizzato nella risposta agli utenti.
Per tale ragione nella definizione di una strategia di decentramento appare centrale il coinvolgimento proprio del management allo scopo di definire preventivamente il suo possibile contributo.
Obiettivo del presente lavoro è, pertanto, l’analisi del contributo del management nella definizione di una strategia di decentramento del SSN.
L’articolo approfondisce il caso della Repubblica di Tunisia come esempio significativo di Paese a medio-basso reddito.

Riferimenti bibliografici

  1. Alves J., Peralta S., & Perelman J. (2013). Efficiency and equity consequences of decentralization in health: an economic perspective. Revista Portuguesa de Saúde Pública, 31(1): 74-83.
  2. Andrews R., Beynon M.J., & McDermott A. (2019). Configurations of New Public Management reforms and the efficiency, effectiveness and equity of public healthcare systems: a fuzzy-set Qualitative Comparative Analysis. Public management review, 21(8): 1236-1260.
  3. Anselmi L. (2014). Percorsi aziendali per le pubbliche amministrazioni: Edizione rivista ed ampliata. Torino: Giappichelli Editore.
  4. Arfa C., & Elgazzar H. (2013). Consolidation and transparency: Transforming Tunisia’s health care for the Poor. UNICO Studies Series 4. Washington DC: The World Bank.
  5. Baccouche N. (2016). Decentralization in Tunisia: challenges and prospects. Federalism – a success story, 1.
  6. Bankauskaite V., & Saltman R.B. (2007). Central issues in the decentralization debate. Decentralization in health care, 9.
  7. Bardhan P. (2002). Decentralization of governance and development. Journal of Economic perspectives, 16(4): 185-205.
  8. Belhedi A. (2017). Disparités régionales en Tunisie. Défis et enjeux. Communication à l’Académie des Sciences, des Lettres & des Arts, BeitAl-Hikma, 7.
  9. Berry A.J., & Otley D.T. (2004). Case-Based Research in Accounting. In: Humphrey C., Lee B. (Eds.). The Real Life Guide to Accounting Research, pp. 231-255. Amsterdam: Elsevier.
  10. Bloom N., & Van Reenen J. (2010). Why do management practices differ across firms and countries?. Journal of economic perspectives, 24(1): 203-224.
  11. Borgonovi E. (2005). Principi e sistemi aziendali per le amministrazioni pubbliche. Milano: Egea.
  12. Bossert T. (1998). Analyzing the decentralization of health systems in developing countries: decision space, innovation and performance. Social science & medicine, 47(10): 1513-1527.
  13. Bossert T., Larrañaga O., & Ruiz Meir F. (2000). Decentralization of health systems in Latin America. Revista Panamericana de Salud Pública, 8: 84-92.
  14. Bossert T.J., Mitchell A.D., & Janjua M.A. (2015). Improving health system performance in a decentralized health system: capacity building in Pakistan. Health Systems & Reform, 1(4): 276-284.
  15. Cepiku D., & Mastrodascio M. (2021). Equity in public services: a systematic literature review. Public Administration Review, 81(6): 1019-1032. © 2021 by The American Society for Public Administration. DOI: 10.1111/puar.13402.
  16. Cheema G.S., & Rondinelli D.A. (1983). Decentralization and development: Policy implementation in developing countries. Beverly Hills: Sage Publications.
  17. Chiucchi M.S., Giuliani M., & Marasca S. (2014). The design, implementation and use of intellectual capital measurements: a case study. Management Control, 2: 143-168.
  18. Çınar F., Eren E., & Mendeş H. (2013). Decentralization in health services and its impacts: SWOT Analysis of Current Applications in Turkey. Procedia-Social and Behavioral Sciences, 99: 711-718.
  19. Dalton J., Chambers D., Harden M., Street A., Parker G., & Eastwood A. (2016). Service user engagement in health service reconfiguration: a rapid evidence synthesis. Journal of health services research & policy, 21(3): 195-205.
  20. Daniels N., Bryant J., Castano R.A., Dantes O.G., Khan K.S., & Pannarunothai S. (2000). Benchmarks of fairness for health care reform: a policy tool for developing countries. Bulletin of the World Health Organization, 78: 740-750.
  21. Eisenhardt K.M. (1989). Building theories from case study research. Academy of management review, 14(4): 532-550.
  22. Faguet J.P. (2014). Decentralization and governance. World Development, 53: 2-13.
  23. Foley C., Droog E., Healy O., McHugh S., Buckley C., & Browne J.P. (2017). Understanding perspectives on major system change: a comparative case study of public engagement and the implementation of urgent and emergency care system reconfiguration. Health Policy, 121(7): 800-808.
  24. Gaynor T.S., & Wilson M.E. (2020). Social Vulnerability and Equity: The Disproportionate Impact of COVID-19. Public Administration Review, 80(5): 832-838. DOI: 10.1111/puar.13264.
  25. Gerring J. (2006). Case study research: Principles and practices. New York: Cambridge University Press.
  26. Hood C. (1995). The “new public management” in the 1980s: Variations on a theme. Accounting, organizations and society, 20(2-3): 93-109.
  27. Jiménez‐Rubio D., Smith P.C., & Van Doorslaer E. (2008). Equity in health and health care in a decentralised context: evidence from Canada. Health economics, 17(3): 377-392.
  28. Kaarbøe O., & Østergren K. (2001). Erfaringer fra ledelses-og organisasjonsreformer i den svenske helsesektoren på 1990-tallet. Helse, økonomi og politikk: Utfordringer for det norske helsevesenet. Oslo: Cappelen.
  29. Maluka S.O., Hurtig A.K., Sebastián M.S., Shayo E., Byskov J., & Kamuzora P. (2011). Decentralization and health care prioritization process in Tanzania: from national rhetoric to local reality. The International journal of health planning and management, 26(2): e102-e120.
  30. Marchal B., Dedzo M., & Kegels G. (2010). A realist evaluation of the management of a well-performing regional hospital in Ghana. BMC health services research, 10(1): 1-14.
  31. Mills A., Vaughan J.P., Smith D.L., Tabibzadeh I., & World Health Organization (1990). Health system decentralization: concepts, issues and country experience. World Health Organization.
  32. Ministero della Salute tunisino (2019). Santé Tunisie en chiffres 2017. Marzo 2019, Repubblica tunisina, Ministero della Salute, Direzione studi e pianificazioni, S/Direzione di statistica.
  33. Mitchell A., & Bossert T.J. (2010). Decentralisation, governance and health‐system performance: ‘Where you stand depends on where you sit’. Development Policy Review, 28(6): 669-691.
  34. Mockford C., Staniszewska S., Griffiths F., & Herron-Marx S. (2012). The impact of patient and public involvement on UK NHS health care: a systematic review. International journal for quality in health care, 24(1): 28-38.
  35. Mookherjee D. (2006). Decentralization, hierarchies, and incentives: A mechanism design perspective. Journal of Economic Literature, 44(2): 367-390.
  36. Muñoz D.C., Amador P.M., Llamas L.M., Hernandez D.M., & Sancho J.M.S. (2017). Decentralization of health systems in low- and middle-income countries: a systematic review. International journal of public health, 62(2): 219-229.
  37. Muriisa R.K. (2008). Decentralisation in Uganda: prospects for improved service delivery. Africa Development, 33(4).
  38. Nuzzo A., Carle F., & Pessina E.A. (2018). Processo di decentramento del SSN ed evoluzione dell’equità interregionale nell’assistenza sanitaria nel periodo 2001-2012. Mecosan, 108: 9-34.
  39. Panda B., & Thakur H.P. (2016). Decentralization and health system performance – a focused review of dimensions, difficulties, and derivatives in India. BMC health services research, 16(6): 1-14.
  40. Parker R.I., & Vannest K.J. (Eds.) (2014). Non-overlap analysis for single-case research. In: Kratochwill T.R., & Levin J.R. (Eds.). Single-case intervention research: Methodological and statistical advances, pp. 127-151. American Psychological Association. Doi: 10.1037/14376-005.
  41. Persiani N. (2002). Modelli di programmazione e sistemi di controllo interno nella pubblica amministrazione. Milano: FrancoAngeli.
  42. Pollitt C., & Bouckaert G. (2003). Evaluating public management reforms: an international perspective. Evaluation in Public-Sector Reform. Concepts and Practice in International Perspective, pp. 12-35. Cheltenham: Edward Elgar Publishing.
  43. Regmi K., Naidoo J., Pilkington P.A., & Greer A. (2010). Decentralization and district health services in Nepal: understanding the views of service users and service providers. Journal of Public Health, 32(3): 406-417.
  44. Rifkin S.B. (2014). Examining the links between community participation and health outcomes: a review of the literature. Health policy and planning, 29(suppl_2): ii98-ii106.
  45. Ryan B., Scapens R.W., & Theobald M. (2002). Research method and methodology in finance and accounting. Lincoln, UK: Cengage Learning EMEA.
  46. Saltman R.B., & Bankauskaite V. (2006). Conceptualizing decentralization in European health systems: a functional perspective. Health Econ. Pol’y & L., 1: 127.
  47. Schneider A. (2003). Decentralization: Conceptualization and measurement. Studies in comparative international development, 38(3): 32-56.
  48. Simonet D. (2010). Healthcare reforms and cost reduction strategies in Europe. International Journal of Health Care Quality Assurance, 23(5): 470-488.
  49. Sumah A.M., Baatiema L., & Abimbola S. (2016). The impacts of decentralisation on health-related equity: A systematic review of the evidence. Health Policy, 120(10): 1183-1192.
  50. Sumah A.M., Bowan P.A., & Insah B. (2014). Decentralization in the Ghana Health Service: A Study of the Upper West Region. Developing Country Studies, 4(12): 45-52.
  51. Tsofa B., Molyneux S., Gilson L., & Goodman C. (2017). How does decentralisation affect health sector planning and financial management? A case study of early effects of devolution in Kilifi County, Kenya. International journal for equity in health, 16(1): 1-12.
  52. Vrangbæk K. (2007). Towards a typology for decentralization in health care. In: Saltman R.B., Bankauskaite V., & Vrangbæk K. (eds.). Decentralization in health care: strategies and outcomes, pp. 44-60. Shoppenhangers Road, Maidenhead, Berkshire, England: McGrawHill Open Unversity Press.
  53. WHO (2018). Tunisia: Health System Profile, Regional Office for the eastern Mediterranee. Region Office for the Eastern Mediterranes. Joint developed by: Department of Health System Development (HSD) and Department of Information, Evidence and and Research (IER) https://rho.emro.who.int/sites/default/files/Profiles-briefs-files/TUN-Health-System-Profiles-2018.pdf.
  54. Wu W., Ma L., & Yu W. (2017). Government Transparency and Perceived Social Equity: Assessing the Moderating Effect of Citizen Trust in China. Administration & Society 49(6): 882-906. DOI: 10.1177/0095399716685799.
  55. Yerkes S., & Muasher M. (2018). Decentralization in Tunisia: Empowering Towns, Engaging People. Carnegie Endowment for International Peace. Washington, DC: Carnegie Endowment for International Peace Publications.
  56. Yin R.K. (2004). The case study anthology. Thousand Oaks, California: Sage.
  57. Yin R.K. (2012). Case study methods. In: Cooper H., Camic P.M., Long D.L., Panter A.T., Rindskopf D., & Sher K.J. (Eds.). APA handbook of research methods in psychology, Vol. 2. Research designs: Quantitative, qualitative, neuropsychological, and biological, pp. 141-155. American Psychological Association. Doi: 10.1037/13620-009.
  58. Zon H., Pavlova M., & Groot W. (2020). Regional health disparities in Burkina Faso during the period of health care decentralization. Results of a macrolevel analysis. The International journal of health planning and management, 35(4): 939-959.

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