1000046 - ECONOMIA SANITARIA

1. Knowledge and understanding: students will know and understand the functioning of healthcare systems, with respect to their organization, financing and delivery of services, as well as the main problems characterizing these systems and the way performance measurement can be a useful information tool for the policies dealing with such problems. Lectures represent the means for the realization of this objective.

2. Applying knowledge and understanding: students will acquire skills for the evaluation of allocative problems characterizing healthcare systems and their components, and will apply knowledge on their functioning as well as the performance measurement tools. Students will be able to evaluate the results of performance measurement in the light of the identification of the most effective policies for improving the outcomes of healthcare systems and the accountability of providers of services. The main tool for the realization of this objective is the preparation of a project work at the end of the course.

3. Making judgments: students will critically assess data, reports and other works on the different aspects of the functioning of healthcare systems and on healthcare policies, identifying the success factors and the challenges facing the systems and the policies. Moments of interaction and active participation of students, during the lectures, with the help of digital tools, will contribute to the realization of this objective.

4. Communication skills: students will gain communication skills and appropriateness in the use of technical language, by means of interaction and active participation activities. The presentation of their project works to the class will also contribute to this objective.

5. Learning skills: the learning skills of students will be improved through an appropriate interaction, the preparation of class presentations, the independent study of parts of the program, which will be presented during lectures along very general lines, and then studied independently by each student.

The course will be structured through lectures; interaction and active participation activities, managed by students, some of them realized with the help of digital tools; practice classes and seminars providing a support for the preparation of the project work. Students will read the teaching material beforehand, especially for preparing class presentations and active participation activities. 

None. It is however advisable that students will review the main notions and models studied in their bachelor degree courses of Microeconomics and Public Finance.

A – ORGANIZATION AND FINANCING OF HEALTHCARE SYSTEMS 

• The architecture of healthcare systems 
• Allocation of resources and organization of healthcare systems 
• The Italian National Health Service and a comparison with other systems 

B – THE FUNCTIONING OF HEALTHCARE SYSTEMS AND HEALTHCARE POLICIES 

• Healthcare needs and healthcare demand 
• The Grossman model
• The agency relation between physicians and patients 
• The supply of healthcare services 
• The models of behavior of hospitals 
• Remuneration mechanisms for hospitals

C – THE EVALUATION OF HEALTHCARE POLICIES AND THE MEASUREMENT OF PERFORMANCE 

• A framework for measuring performance of healthcare 
• The dimensions of healthcare performance 
  • Health
  • Clinical quality and appropriateness
  • Financial protection 
  • Equity
  • Efficiency

1. R. Levaggi e S. Capri (2013), Economia Sanitaria, Franco Angeli, chapters 1, 2, 3, 9, 10
2. G. Turati (2013), The Italian Servizio Sanitario Nazionale: A renewing tale of lost promises, in J. Costa-Font, S.L. Greer (eds.), Federalism and decentralization in European health and social care, Palgrave MacMillan, p. 47-66
3. E. Caruso e N. Dirindin (2011), Costi e fabbisogni standard nel settore sanitario: le ambiguit  del decreto legislativo n. 68 del 2011, Quaderni del Dipartimento di Economia, Fin anza e Statistica dell'Università di Torino, n. 100, p. 1-26
4. G. Arachi e A. Zanardi (2010), Tutto ruota intorno ai fabbisogni standard, Lavoce.info, p. 1-3 (https://www.lavoce.info/archives/26591/tutto-ruota-intorno-ai-fabbisogni-standard/)
5. CERGAS Bocconi (2021), Rapporto OASI 2021, chap. 2, 3 (https://www.cergas.unibocconi.eu/observatories/oasi_/oasi-report-2021)
6. I. Papanicolas e P.C. Smith (2013), Health system performance comparison, Euroepean Observatory on Health Systems and Policies, Open University Press, chapters 5, 6, 7, 8, 10 (https://www.euro.who.int/__data/assets/pdf_file/0009/244836/Health-System-Performance-Comparison.pdf)

For those interested in further readings on the topics under A and B, in an international perspective: J.Bhattacharya, T.Hide e P.Tu (2013), Health Economics, Macmillan International Higher Education (especially chapters 2, 3, 5, 6, 7, 16, 17, 18). 

The assessment is consistent with the structure of the teaching activity, and it is aimed at verifying the students' outcomes in terms of the main learning objectives. It is carried out according to the following structure:

• Active participation to the teaching activity - Active participation of students during classes is realized through individual and group presentations (e.g., guided class discussions), and interaction, also by means of digital applications. For each student, the continuity and quality of participation during classes will be assessed, and this evaluation is worth 30% of the overall assessment. 
• Written test - It consists of a set of exercises and open-ended questions, on parts A and B of the program. The test will be run at the end of the course, on the 22nd of December, 2022. Time allowance is 90 minutes. The score for the test is worth 30% of the overall assessment. 
• Project work - The main objective of the project work is applying the knowledge developed during the course and, in particular, in the part C of the program, as well as showing the capacity of critical evaluation of this knowledge. Self-selected groups od 2-3 students will submit a proposal whose main objective is the measurement of performance, along one or more of the different dimensions of performance studied in part C, of healthcare systems or of their units. The project work will include a discussion of the results of the measurement exercise, the weaknesses and strengths of the measurement, and the recommendations to the potential decision-makers in terms of policies and/or actions to be taken to deal with the critical issues arising from the measurement exercise. Detailed guidelines will be provided in due course. The seminars on the techniques of data analysis will provide the methodological support for the performance measurement exercise. Further support is guaranteed by the interaction with the lecturer. Each group will present its project work during a class discussion with the other students (20 minutes for presentation and 10 minutes for discussion). Presentations will be held on the 10th and the 11th of January, 2023. The score for the project work is worth 40% of the overall assessment. 

Students not attending the course will be assessed in a different way, by means of a written test and an oral exam. The written test will consist of 8 open-ended questions. 6 questions are meant to check the students' ability to use and apply their knowledge of the main topics of the course, and they will require a short and concise answer. The other 2 questions will require a longer answer on two different arguments, chosen in a group of three questions each. Students who will achieve at least a score of 18/30 in the written test will be admitted to the oral exam. The written test and the oral exam will deal with all the topics of the course.