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The Evolution of Decisional Logic in the Healthcare System

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Evaluating Investments in Health Care Systems

Part of the book series: SpringerBriefs in Health Care Management and Economics ((BRIEFSHEALTHCARE))

Abstract

In the current context of international economy crisis, the control of public expenditure appears to be now a diktat imposed by finance institutions, to ensure continued economic growth and, at least, maintain the levels of well-being achieved by individual nations. In these scenarios, the economic evaluation of public and private decisions, if equipped with collective importance, enters fully into the behavioral ethics of the policy makers and technocrats called upon to manage the public sector. In recent years, several approaches have been developed, in a business management perspective, for the study and innovation of Public Administration (PA). These frameworks of ideas, apart from some significant conceptual differences, have in common the goal of improving efficiency, effectiveness, economic and equitable decision-making and operations implemented by the various companies that make up the Public Administration.

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Notes

  1. 1.

    Regarding this, Ferrara (1993, 1994) indicates the need to establish a balance among the interests of public companies, like other sub-balances of corporate management, as its failure to do so over time is likely to alter the overall income balance of the company.

  2. 2.

    According to Luder (1994), the processes of public administration reform can be explained through the contingency sample model. According to this model, the changes are induced by the onset of external factors (reduction of financial resources) and structural factors (political will and ability for top management of the public).

  3. 3.

    Good governance in the public sector, according to the document prepared by the World Bank in 1992, refers to the logic that should be followed for the proper management of public affairs. These approaches include: the need to equip themselves with systems of budgeting and control systems for the efficient management of human and financial resources, the introduction of standards and tools capable of empowering leadership on the efficiency and effectiveness of their work, the introduction and strengthening of accountability for the recovery of administrative action transparency in order to facilitate stakeholder monitoring.

  4. 4.

    The bureaucratic logic, inspired by the principles of social structuralism and absolute rationality, aims to achieve the best, starting from the limits of restricted rationality, through the elimination of elements of subjectivity in individual behavior. The bureaucratic sample model theorizes some principles, briefly reported below, to be used in guiding complex organizations: the principle of specialization and division of labor; principle of scientific theory and experimental scientific city; principle of preventive standardization of tasks and duties; principle of impersonality; principle of hierarchy (Borgonovi 2002). Weber maintained (1961), that bureaucracy, although not characteristic of social organization of industrial capitalism and deep-rooted in other types of economies, found its full realization based on the principles of rationality and legality. Rational bureaucratic action ensured standardization and uniformity of State operation. Regardlessly, the universality of law regulated objectives, processes and outcomes.

  5. 5.

    The examples cited are: the “Gore report” in the United States (a government that works better and costs less), the “Next Step Program” launched in the UK during the Margaret Thatcher government, the various national programs called “Financial Initiatives Management” (UK, Australia), the state reform started in New Zealand and the “Public Service 2000” initiative of Canada.

  6. 6.

    Please refer to the first study, for a more detailed analysis of the NPM, Meneguzzo (1994), Mascarenhas (1993), and Hood (1991).

  7. 7.

    A paradigm can be considered as the set of values, beliefs and techniques shared by members of a particular community (Kuhn cited in Massey 1997). The NPM can be considered a new paradigm, having contributed to changes in values, beliefs and techniques with reference to the study of PA.

  8. 8.

    Pollitt (1990, 1993), similarly see Hood (1991, 1995) who considers NPM an ideological model and promoter of the need to convey the logic developed in the public sector into the field of private law.

  9. 9.

    In this respect, please refer to Gruening (1998).

  10. 10.

    Other reforms have interested PA in a systematic way in the past. It is important to mention the so called classic Public administration of the 20s of the last century, but you could go even further back in time citing the Napoleonic reforms.

  11. 11.

    For more details, please refer to the thoughts of Aucoin (1990), Dunsire (1995), Schendler (1995), Luder (1996), Schendler and Proeller (2000).

  12. 12.

    For more details, please refer to Buchanan and Tullock (1962), Arrow (1951, 1963).

  13. 13.

    Cfr. Luder (1996), Naschold et al. (1995), Reichard (1996), Schendler (1995).

  14. 14.

    Refer to Enteman (1993) and Pollitt (1990).

  15. 15.

    Traditionally, proponents of this approach have encouraged the application of the decision-making processes of public operators and methods developed from the studies of public policy, including those of cost-benefit analysis. The use of sophisticated techniques in order to reduce the uncertainty is characterized by a matrix rationalistic that the Quantitative/Analytic management shares with the Scientific Management. For more details see: Lynn (1996).

  16. 16.

    The studies related to Liberation management, which have developed since the early nineties, revolve around the idea that the stiffness and the constraints of traditional bureaucracies, preventing public managers to express their potential, are the cause of generalized dysfunction that exists in public administration. The improvement cannot, therefore, avoid passing through the de-bureaucratization of the processes and the rationalization of organizational structures. To streamline public bureaucracies, proponents of Liberation propose management solutions like decentralization of the functions of budgeting and management of personnel, the simplification of procedures and outsourcing (Light 1997; Osborne and Gaebler 1992).

  17. 17.

    For further reference on the subject, please refer to Gnecchi (2004).

  18. 18.

    The systematization of the theoretical foundations that NPM is based on conducted by Gruering (1998) and by Macinati (2004: 104) seem very interesting.

  19. 19.

    Please refer to Lynn (1996).

  20. 20.

    The classical theory of economics, that heralds Adam Smith as one of its greatest exponents, assumed that private interest could “guarantee” the fulfillment of the collective interest thanks to the doing of the forces involved in the market: the interaction of demand and supply would generate prices balance capable of satisfying the parties, thereby ensuring natural situations of equilibrium. Hence, the liberal economic policies, inspired by Smith, tend to promote the removal of any restriction to the free unfolding of market forces and to outline a substantially reductive role for the state. However, the liberal position has progressively proved itself not in line with reality.

  21. 21.

    This statement is in perfect harmony with the statements of the corporate economic doctrine that defines corporate phenomenon as unitary and speculative to eventual classification.

  22. 22.

    Already by end of the 40s of the last century Simon (1947), diffused a new theoretical approach to PA focused on the predominance of the managerial model based on objectives and means compared to the bureaucratic one based on rules and procedures.

  23. 23.

    With reference to this last point, namely the reduction of bureaucratic constraints, it is seen above all the theories of Osborne and Gaebler (1992), that, just as it proved in practice, the route taken was that of the processes of deregulation and decentralization of operating systems, such issue will then be discussed in depth in the course of this work.

  24. 24.

    It should be noted that the process of decentralization has had different degrees of intensity in different countries depending on the institutional context of reference. For example, Anessi Pessina and Cantù (2001: 70) identify three different ways to implement ways and degrees through which the processes of decentralization, devolution, federalism, vertical subsidiary.

  25. 25.

    In fact, often, this separation of roles appears only as a formal as evidenced by the numerous news stories reported in our country and abroad.

  26. 26.

    Also in this case, practice has often failed to comply with expectations of the theory, to consider the variable compensation as ancillary component of remuneration is not necessarily linked to the achievement of specific objectives.

  27. 27.

    “Empirical studies into the factual reality of management are scarcer than the many theories” Kickert (1994a).

  28. 28.

    See Ashburner (1994) and Meneguzzo (1995).

  29. 29.

    Kooiman and Van Vliet (1993), Minogue et al. (1998), Kickert (1995a).

  30. 30.

    Consistent with studies conducted according to the contingency theory model, are the organizational and environmental precondition determine, even in the presence of the same external stimuli to change, significant differences in the results obtained with the processes of change, so any innovation process should be preceded by an analysis of the context in order to avoid a mechanistic introduction of the not in line with new logical.

  31. 31.

    The term decision analysis was coined in 1967 by Ronald A. Howard professor at Stanford University.

  32. 32.

    For a close international examination, please refer to Kickert (1995b).

  33. 33.

    The activity of public companies is aimed at citizens, not consumers or customers (Minogue et al. 1998). On the one hand, they expect efficient public services and taxation policies to reduce tax the burden, on the other hand, however, ask that their rights be protected, that their voice be heard, that their values and their preferences be respected.

  34. 34.

    In particular for the analysis of the points of contact between NPM and PG refer to Hogwood (1995).

  35. 35.

    Therefore, as for companies also PA is studied with a systemic perspective whose characteristics are: the system is open, as it presents continuous interchanges with the outside; dynamic, as it changes over time and space; complex, given that there are many elements and relationships that make it up; finalistic, as it has the ability to achieve a result; probabilistic, because its operation is subject to uncertainties and risks. Systemic studies in business economics reference, please refer to Amaduzzi (1969), Giannessi (1969), Bertini (1990).

  36. 36.

    While the reforms inspired by the NPM movement focus on a number of necessary measures for the recovery of efficiency, at times so pushed as to seem too farfetched compared to the original mission of the institution, governance aims at effectiveness without humiliating public interests.

  37. 37.

    “The logic of governance is more consistent with the pattern of organization/institution that emanates economic policies, produces services or regular economic activities of other parties” Borgonovi (2002: 41–42).

  38. 38.

    For an in depth analysis on the meaning of the concepts of complexity, differentiation and dynamic public environment, please refer to Kickert (1994b).

  39. 39.

    According to Kooiman and Van Vliet (1993) the characteristic of PG is to start from the analysis of the external environment in order to define the different policies within PA, namely PG reverses the logic of NPM to assign itself priority to inside measures and only later decide to look at the relationship between public and environment.

  40. 40.

    In the process of change referred to, the public administrator from passive executor of administrative law becomes active subject in the production of rules. In other words, through the issuing of regulations to define the organizational procedures necessary to implement in the specific company reality where the general requirements laid down by the legislature operate, the director the is the interpreter of the provisions of law.

  41. 41.

    Savas (2000), Oliver and Ebers (1998).

  42. 42.

    For a detailed analysis on the meanings given to the term governance in international references see Longo (2005: 16).

  43. 43.

    Cfr. Rebora and Meneguzzo (1990).

  44. 44.

    See also Kooiman (2003) according to whom, for every acting agent in the network, the rewards are potentially greater than contributions offered.

  45. 45.

    Please refer to Meneguzzo (1995: 506).

  46. 46.

    In accordance with the principles of consent, and the criteria of economic efficiency and functionality and of concrete technical, organizational, economic and social feasibility, i.e. taking into account “diversity of interests to adopt policies, guidelines and choices able to align interests toward mutually acceptable solutions” (Borgonovi 2002: 42).

  47. 47.

    Further on in this work, the relationship between PA and the system of acting party who in various ways are involved in supplying health goods and services will be analyzed.

  48. 48.

    Regarding public interest networks, see Longo (2005: 34 ff), Kickert (1994b).

References

  • Amaduzzi A (1969) L’azienda nel suo sistema e nell’ordine delle sue rilevazioni. Utet, Torino

    Google Scholar 

  • Annessi Pessina E, Cantù E (2001) L’aziendalizzazione della sanità in Italia. Egea, Milano

    Google Scholar 

  • Arrow KJ (1951) Social choice and individual values. Wiley, New York

    Google Scholar 

  • Arrow KJ (1963) Social choice and individual values. Wiley, New York

    Google Scholar 

  • Ashburner A (1994) The composition of NHS trusts board. Health Serv Manage Res 7(3)

    Google Scholar 

  • Aucoin P (1990) Administrative reform in public management: paradigms, principles, paradoxes and pendulums. Gov Int J Policy Adm 3:115–137

    Google Scholar 

  • Bertini U (1990) Il sistema d’azienda. Schema di analisi. Giappichelli, Torino

    Google Scholar 

  • Borgonovi E (1996, 2000, 2002), Principi e sistemi aziendali per le amministrazioni pubbliche. Egea, Milano

    Google Scholar 

  • Buchanan JM, Tullock G (1962) The calculus of consent: logical foundations of constitutional democracy. Ann Arbor 1962. University of Michigan Press, Michigan

    Google Scholar 

  • Dunsire A (1995) Administrative theory in the 1980s: a viewpoint. Public Adm 75

    Google Scholar 

  • Enteman W (1993) Managerialism: the emergence of a new ideology. The University of Wisconson Press, Wisconsin

    Google Scholar 

  • Ferrara G (1993) Economicità e solidarietà nei servizi sanitari. Atti II Convegno Annuale SVIMAP La programmazione e il controllo nelle aziende sanitarie pubbliche, Cagliari, 1993

    Google Scholar 

  • Ferrara G (1994) Il rapporto impresa-ambiente: la ricerca nelle disci-pline economico-aziendali, Economia e diritto del terziario 6

    Google Scholar 

  • Giannessi E (1969) Considerazioni critiche intorno al concetto di azienda. In: AA. VV (eds) Scritti in onore di G. Dell’Amore, Saggi di discipline aziendali e sociali, vol I, Giuffrè, Milano

    Google Scholar 

  • Gnecchi F (2004) I rapporti tra imprese di pubblici servizi ed enti lo-cali. Symphonya—Emerging Issues in Management, Issue 1, ISTEI-Università Milano-Bicocca

    Google Scholar 

  • Gore A (1993) From red tape to results. Creating a government that works better and costs less. Government Printing Office, Washington, D.C

    Google Scholar 

  • Greer P (1994) Transforming central government: the next steps initiative. Buckingham and Open University Press, Philadelphia

    Google Scholar 

  • Gruening G (1998) Origini e basi teoriche del new public management. Azienda Pubblica 6

    Google Scholar 

  • Gruening G (2001) Origin and theoretical basis of new public management. Int Public Manage J 4:1–25

    Article  Google Scholar 

  • Hogwood B (1995) Patterns and diversity in administrative reform. Conferenza del Gruppo Europeo della Pubblica Amministrazione dell’Istituto Internazionale di Scienze Amministrative su Approcci europei ed americani al management pubblico, Amsterdam Settembre 1995

    Google Scholar 

  • Hood C (1991) Public management for all seasons? Public Adm 69:3–19

    Article  Google Scholar 

  • Hood C (1995) The new public management in the 1980s: variations on a theme. Acc Organ Soc 20:93–109

    Article  Google Scholar 

  • Jones LL, Thompson F (1997) L’implementazione strategica del New public management. Azienda Pubblica 6

    Google Scholar 

  • Kettl DF (1997) The global revolution in public management: driving themes, missing links. J Policy Anal Manage 16:446–462

    Article  Google Scholar 

  • Kickert WJM (1994a) Administrative reform in British, Dutch and Danish Civil service: towards policy making core departments and autonomous executive agencies. Erasmus University Rotterdam, Rotterdam

    Google Scholar 

  • Kickert WJM (1994b) Complexity, governance and dynamics: conceptual explorations of public network management. In: Kooiman J (ed) Modern governance. New government-society interactions. Thousand Oaks, New Delhi: Sage, London

    Google Scholar 

  • Kickert WJM (1995a) Public governance in the Netherlands. An alternative to Anglo American managerialism. In: Conferenza del Gruppo europeo della Pubblica Amministrazione dell’Istituto internazionale di Scienze Amministrative su Approcci europei ed americani al management pubblico. Amsterdam Settembre 1995

    Google Scholar 

  • Kickert WJM (1995b) Steering at a distance: a new paradigm of public governance in Dutch higher education. Governance 8(1)

    Google Scholar 

  • Kickert W, Klijn EH, Koppenjan JFM (eds) (1997) Managing complex networks, strategies for the public sector. Sage Publications, London

    Google Scholar 

  • Kooiman J (2003) Governing as governance. Sage Publication, London

    Google Scholar 

  • Kooiman J, Van Vliet M (1993) Governance and public management. In: Eljassen KA, Kooiman J (eds) Managing public organizations, lessons from contemporary European experience. Sage Publications, London

    Google Scholar 

  • Longo F (2005) Governance dei network di pubblico interesse. Egea, Milano

    Google Scholar 

  • Light PC (1997) The tides of reform: making government work press. Yale University Press, New Haven, CT

    Google Scholar 

  • Luder K (1994) Accounting for change: market forces and managerialism in the public sector. Speyer arbeitshefte, Speyer

    Google Scholar 

  • Luder K (1996) Triumph des Marktes im oeffentlichen Sektor?—Eini-ge Anmerkungen zur aktuellen Verwaltungsreformdiskussion. Die o-effentliche Verwaltung 49

    Google Scholar 

  • Lynn LE (1996) Public management as art, science and profession. Chatman House, New York

    Google Scholar 

  • Macinati M (2004) Le relazioni interaziendali di collaborazione in sa-nità. FrancoAngeli, Milano

    Google Scholar 

  • Mascarenhas RC (1993) Building an enterprise culture in the public sector: reform of the public sector in Australia, Britain and New Zealand. Public Adm Rev 4

    Google Scholar 

  • Massey A (1997) Globalization and marketization of government services. Macmillan, London

    Google Scholar 

  • Mclaughlin K, Osborne SP, Ferlie E (2002) New public management: current trends and future prospects. Routledge, London

    Google Scholar 

  • Meneguzzo M (1994) Reiventare la sanità statunitense. Teorie e scelte manageriali. Mecosan 12

    Google Scholar 

  • Meneguzzo M (1995) Dal New public management alla public governance: il pendolo della ricerca sulla amministrazione pubblica. Azien-da Pubblica 1

    Google Scholar 

  • Meneguzzo M (1997) Ripensare la modernizzazione amministrativa e il New public management. L’esperienza italiana: innovazione dal basso e sviluppo della governance locale. Azienda Pubblica 6

    Google Scholar 

  • Minogue M, Polidano C, Hulme D (1998) Beyond the new public management: changing ideas and practices in governance. Wayne Parsons, London

    Google Scholar 

  • Naschold F, Oppen M, Tondorf K, Wegener A (1995) Neue Staedte braucht das Land—Public Governance: Strukturen, Prozesse und Wir-kungen kommunaler Innovationsstrategien. In Europa—Eine Projekt-skizze, Berlin 1995, Wissenschaftszentrum Berlin

    Google Scholar 

  • Oliver A, Ebers M (1998) Networking network studies: analysis of conceptual configurations in the study of interorganizational relationships. Organ Stud 19:549–583

    Article  Google Scholar 

  • Osborne D, Gaebler T (1992) Reiventing Government: how the entrepreneurial spirit is transforming the public sector. Penguin, New York

    Google Scholar 

  • Peters BG (1996) The future of governing: four emerging models. The University Press of Kansas, Lawrence

    Google Scholar 

  • Pollitt C (1990) Managerialism and the public services: the anglo American experience. Basil Blackwell, Oxford

    Google Scholar 

  • Pollitt C (1993) Managerialism and the public services, II edn. Black-well, Oxford

    Google Scholar 

  • Rebora G, Meneguzzo M (1990) Strategia delle Amministrazioni Pubbliche. UTET, Torino

    Google Scholar 

  • Reichard C (1996) Die ‘New Public Management’-Debatte im internationalen Kontext. In: Reichard C, Wollmann H (eds), Kommunalver-waltung im Modernisierungsschub? Basel u.a., Birkhaeuser

    Google Scholar 

  • Rhodes RAW (1997) Understanding governance, policy networks, governance, reflexivity and accountability. Open University Press, Buckingham

    Google Scholar 

  • Savas ES (2000) Privatizations and public-private partnerships. Seven Bridges Press, New York

    Google Scholar 

  • Schendler K (1995) Zur Vereinbarkeit von wirkungsorientierter Verwaltungsfuehrung und Demokratie. In: Swiss Political Science Review, vol 1

    Google Scholar 

  • Schendler K, Proeller I (2000) New public management. Paul Haupt, Bern

    Google Scholar 

  • Simon HA (1947) Administrative behaviour. The Free Press, New York

    Google Scholar 

  • Walsh K (1995) Public services and market mechanisms. Competition, contracting and the new public management. Macmillan Press, London

    Google Scholar 

  • Weber M (1961) Economia e società. Edizioni di Comunità, Milano

    Google Scholar 

  • Zifcak S (1994) The New Managerialism: administrative reform in Whitehall and Canberra. Open University Press, Buckingham

    Google Scholar 

Download references

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Scaletti, A. (2014). The Evolution of Decisional Logic in the Healthcare System. In: Evaluating Investments in Health Care Systems. SpringerBriefs in Health Care Management and Economics. Springer, Cham. https://doi.org/10.1007/978-3-319-02544-5_1

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