scholarly journals The medicalisation of politics or the politicisation of pedicine: the case of italian struggles to design public healthcare institutions

DAT Journal ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 75-94
Author(s):  
Valeria Graziano ◽  
Maddalena Fragnito
Keyword(s):  
National Health Service ◽  
Health Service ◽  
Healthcare Sector ◽  
Public Healthcare ◽  
Healthcare Design ◽  
Key Characteristics ◽  
Italian National Health Service ◽  
History Of ◽  
Italian National Health ◽  
Key Aspects

In the present article, we reflect on some key aspects for the design of pub­lic health systems by retracing the history of the Italian National Health Service, or Servizio Sanitario Nazionale (SSN), from its inception to the present days, analysing how a series of subsequent reforms and counter-reforms impacted its functions and services. Our reflection is based on a collective interview with Fulvio Aurora, Paolo Fierro and Edoardo Turri, three members of Medicina Democratica, which has been and continues to be one of the key organizations in the struggles for keeping health a public value in Italy. While our standpoint on the issue of health is geographically situated, we believe that an analysis of the Italian healthcare sector, with its success­es and its failures, can offer important points of departures for identifying some key characteristics to shape contemporary approaches to healthcare design that can be translocal and cosmopolitan in their application.

Lights and shades in the managerialization of the Italian National Health Service

2008 ◽  
Vol 21 (4) ◽  
pp. 248-261 ◽  
Author(s):  
Federico Lega
Keyword(s):  
National Health Service ◽  
National Health ◽  
National Health System ◽  
Critical Assessment ◽  
Field Investigations ◽  
Italian National Health Service ◽  
History Of ◽  
Italian National Health ◽  
Interpretative Framework ◽  
Do So

After fifteen years from the first of a series of reforms that introduced managerial paradigms and techniques into the Italian National Health System (INHS), it is possible to provide a critical assessment of the outcomes of such changes. The aim of this paper is to assess how these reforms have changed the INHS, to what extent they concurred to improve the system, where they failed and which issues are still in agenda. To do so we run through the recent history of the INHS and propose an interpretative framework to understand the grounds for its light and shade results. The basis for the analysis is triple. The study draws from researches, literature review, action-researches and field investigations conducted over the last 10 years in the INHS.

scholarly journals Auxological criteria for the diagnosis of GH-dependent short stature and prescription of rGH: problems and pitfalls

2007 ◽  
Vol 1 (4) ◽  
pp. 165-170
Author(s):  
Giulio Gilli ◽  
Lodovico Benso ◽  
Lorenzo Pradelli
Keyword(s):  
Growth Hormone ◽  
National Health Service ◽  
Health Service ◽  
Short Stature ◽  
Recombinant Growth Hormone ◽  
Italian National Health Service ◽  
Italian National Health ◽  
Parental Height ◽  
Gh Deficit ◽  
Therapeutic Responses

Recombinant growth hormone (rGH) administration is a cornerstone in the treatment of short stature secondary to GH deficit. Since its introduction in the 80s, the population of short patients with an indication to rGH therapy has clearly broadened, probably because of increased awareness by patients and physicians. Since rGH therapy is demanding for patients and expensive, the Italian National Health Service, like other third payers and regulatory authorities, regulates its prescription according to criteria listed in the Nota AIFA 39. This paper illustrates pitfalls and difficulties paediatricians may encounter when assessing short stature patients in order to decide upon the opportunity and possibility to initiate rGH therapy through the exposition of four emblematic, though hypothetical, clinical histories. In the discussion, the Authors highlight some of the most critical points in the formulation of the Nota 39, among which are the lack of clear reference values, neglecting of parental height targets and therapeutic responses, as well as some omissions in methodology specifications.

scholarly journals The effects of disease cross-coverage by dupilumab on the costs sustained by the Italian National Health Service

2020 ◽  
Vol 7 (1) ◽  
pp. 33-39
Author(s):  
Claudio Jommi ◽  
Filippo Cipriani ◽  
Francesca Fanelli ◽  
Maria Paola Pedone ◽  
Walter Canonica
Keyword(s):  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Economic Benefit ◽  
Severe Atopic Dermatitis ◽  
Crowding Out ◽  
Alternative Treatments ◽  
Published Evidence ◽  
Italian National Health Service ◽  
Italian National Health

Background and research question: Label extension for treatments and the relevant disease cross-coverage may produce an economic benefit. This paper assesses this benefit for dupilumab in the perspective of the Italian National Health Service. Dupilumab was approved for reimbursement for severe atopic dermatitis (AD), severe and refractory asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). The analysis focused on the crowding-out effect of dupilumab on alternative treatments. Methods: The research relied on a simplified budget impact model. The model was populated by data from published evidence and relied on three alternative scenarios for market penetration (15%-30%-100%). Results: Avoidable direct health annual costs due to cross-coverage for (i) asthma in patients treated for AD ranged from 0.46 to 3.43 million euros, (ii) asthma in patients treated for CRSwNP ranged from 0.08 to 0.88 million euros, (iii) CRSwNP in patients treated for asthma ranged from 0.41 to 4.05 million euros respectively. The total economic benefit ranges from 0.95 to 8.36 million euros. Discussion: The research estimated the crowding-out effect of dupilumab on alternative treatments. It did not incorporate avoided/incremental events due to a possible better/worse risk-benefit profile of dupilumab vs alternative treatments and the economic benefit of cross-coverage on lower diseases severity (for example mild asthma). Nonetheless, the analysis relies on the best available evidence for Italy to shed light on a topic which has not been sufficiently investigated, and provides data that will be potentially very important for policy-makers, payers and those who manage new treatments.

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