Models of Governance in the Local Health Districts. Real Actors and Processes of Some Italian Regions

The evolution of several well known factors is at the basis of the transformation of the welfare models and health systems in many countries. A structural change has involved the continuity of care between hospital and territory and the primary care system.

The keywords of this new change are: greater relevance of the territorial organizational models of health services (Districts); greater integration between health and social services; care focused on the person and the role of the caregiver; integration and co-ordination of professionals (case-management) work with and within the community (community welfare).

Aims

1) analysis of the occurred change in some selected Italian regions as for the innovation of care processes at the territorial level with a focus on the primary and intermediate care system (role of districts) and personalized treatment processes of patients with specific chronicity; 2) focus on a territorial level aimed at the reconstruction of both documents and phenomena of the organizational aspects and of the relevant processes put in place and of territorial governance.

Methodology

1) literature review on the subject; 2) Use of following Indicators: financing the systems; the providers; the processes and forms of regulation in the socio-sanitary system; 3) Building a 6-macro analysis grid with over 200 indicators to investigate both the regulatory level and the phenomenal level on: System Mix (Public/Private/Citizenship) and Production Process of the Social-Health Performance System; 4) Interviews on the processes of taking in charge of autonomous chronic patients.

Results

1)Assessment of the necessary re-balance of resources and activities between hospital and territory; 2) centrality of the district and territory compared to the hospital; 3) participation and programming of services in an integrated governance logics; 4) implementation of enabling goals; 5) focusing on the cultural and social features of chronic patients; 6) organizational and professional resilience to change.