Modelli regionali di partecipazione in sanità. Uno studio comparativo

One of the main dynamics of change in the Italian welfare system since the 1970s has been the restructuring of decision-making processes to encourage participation. Today, the new millennium presents evidence of the growing protagonism of the public service authorities in this process. This leading role heralds ambivalent outcomes;although it expresses an attempt to retain the public service’s role as guarantor of fundamental rights, it also lends itself to processes of de-accountability of the same public body. Twenty years after the reform of Title V of the Italian Constitution, this article examines and compares the institutional representations of the role of citizens-users/patients in five regional health systems in Italy. Our study, conducted using the Delphi technique, identified the instruments currently applied and the impact of the 2020/2021 Covid pandemic on the regional systems. The results highlight some interesting experiments in the direction of overcoming the traditional “democratic deficit” of the health system;even if the organizational, communicative, cultural and training challenges of “competent” citizens and communities remain open and further accentuated after the Covid-19 pandemic. Copyright © FrancoAngeli

Vulnerability and resilience of the European health care systems in the face of the Covid-19 pandemic: A framework for the comparative analysis of problematic sentinel cases

The main results in terms of inter-regional and intra-regional variations of the application of the concept of "health macro-region" are presented in the first part of the article in order to show how the European health care systems have differently coped with the COVID-19 outbreak. Given the high levels of intra-regional variation found, it seemed appropriate to also add an analysis by country in order to identify those "sentinel cases", given their alert value, which recorded the worst ratio between the infection rates (cases/population) and the lethality rates (deaths/cases). In order to explore the possible reasons behind the problematic coping with the pandemic of these "sentinel cases", a conceptual framework for the analysis of vulnerability, resilience and their governance in terms of sustainability of health care systems is developed in the second part, hoping its application could represent a useful contribution for best-practice solutions that could guide the management of future pandemics. © 2021 Franco Angeli Edizioni. All rights reserved.