Regulation, Financing, Purchasing And Production Processes In Health Systems. Towards A “Value” Health Care

Health system performance is usually discussed and declined in relation to general outcomes, most often expressed via indicators such as life expectation at birth or an increase in the avoidable mortality rate. This stems from a macro perspective, which incorporates dimensions such as a population's epidemiological conditions or the degree of economic development of specific countries. Few contributions have looked at processes and structures to identify specific virtuous aspects which characterize different health systems and contribute to value creation, which is paramount for any public sector organization. This paper aims to contribute to the ongoing debate on the sustainability of public healthcare spending with an approach stemming from the theory of Public Value, which is both complementary and in some ways alternative to the paradigms of New Public Management and Governance and has evolved over time from issues regarding public value conceptualization to those concerning its creation and measurement. In particular, it deals with the merits of specific mechanisms of different health systems, namely financing models, the degree of fiscal decentralization, production set-ups and inter-institutional collaborations, in order to verify whether and to what extent various solutions can contribute to improving performance and creating public value.