Abstract :
Since the beginning of the 1990s, health policy in Italy has been
characterised by continuous reform as reflected by the frequency of new
measures. Importantly, the reforms have changed considerably many aspects of
the health-care system, including the governance of medical performance. The
new measures fall into two types: regionalisation and transformation of local
providers into ‘health-care enterprises’. In relation to the governance of medical
performance, more specifically, the reforms have entailed the introduction of
budgeting and quality assurance, the creation of new managerial roles, and the
transformation of existing roles, as well as the introduction of new mechanisms
for evaluating medical performance. In terms of the specific forms of
governance, the reforms have reinforced hierarchy-based forms of governing
intermeshed with party governance, and have re-defined professional selfregulation
by strengthening collective forms of professional self-regulation. The
design and implementation of the reforms are subject to a complex process of
negotiation, which involves a wide range of actors spread across different levels
of governance and takes place in relation to all aspects of the governance of
medical performance.
