Making governance work in the healthcare sector: evidence from a “natural experiment” in Italy

The Italian Health Care System is a public health system which provides universal coverage for comprehensive and essential health services through general taxation. Since the early 1990s, a strong decentralization policy has taken place in Italy and the State has gradually ceded its jurisdiction to the 20 Italian Regions. These Regions now have the political, administrative, and financial responsibility for the provision of health care to their residents. This shift of power has created some interregional differences in the quality of healthcare services. However, eight Italian Regions have adopted the same Performance Evaluation System (PES) since 2008. It was designed and implemented to monitor about 160 indicators. The Regional Network has offered valuable information and the opportunity to adopt managerial tools that can be used to drive performance improvement and achieve equity. This paper firstly describes the methodology followed by the eight Regions in defining their priorities and setting their targets, relying on the multidimensional data the Inter-Regional Performance Evaluation System provides. It secondly enquires how some Regions have applied and adapted this methodology to their characteristics and strategies.