La comparazione dei sistemi sanitari. Uniformità, eterogeneità e risultati

The 2008 financial and economic crisis has strongly strengthened the theme of sustainability of health expenditure and its rationalization. Since the second post-war period, institutions and scholars have widely investigated the so-called technical efficiency of health policies, looking for best practices and solutions able to combine results and resources better than the others. This contribution aims at verifying whether the overall picture that emerges provides clear policy guidance to decision makers; if not, to understand the related reasons and propose new perspectives of analysis. The approach adopted is that of the Italian “economia aziendale” tradition with an international outlook. It is specifically related to the consolidated experience of measurement and control systems, also in the perspective of company networks. The scientific literature of the past 15 years has been analyzed together with important institutional sources: databases from OECD, from World Health Organization and from the Sanitary Management Laboratory of Sant’Anna School of Advanced Studies in Pisa have been consulted. The overall picture emerging from the reconnaissance is fragmentary and obscure, even contradictory in same cases. By abstraction and partial generalization, it is possible to argue that the various perspectives of the studies adopted by the scholars together with the different meanings of health performance are the possible causes. Measuring business outcomes or business systems, especially when proposed in a comparative perspective, presupposes indeed the identification of clear measures and indicators that should be designed in coherence with the contexts observed, notably structural and process characteristics. The contribution thus focuses on these aspects, mainly in methodological terms, in order to draw the attention of management scholars to the comparison of health systems, and wishing for their deeper involvement in the international debate. The final auspice is that a complementary view to the sociological, political, and macro-economic ones will be offered to the politic decision makers soon.