The long process by which HTA became a paradigm: A longitudinal conceptual structure analysis.

This study maps the conceptual structure of health technology assessment (HTA) research with the aim of contributing to a better understanding of this research stream. A bibliometric analysis of 1,198 HTA articles retrieved from the Web of Science database was conducted. The analysis of descriptive performance indicators identified the main traits of the scientific debate about the HTA in terms of publications, productive countries, and sources. A co-word analysis was performed by adopting social network analysis tools to map the conceptual structure of the dataset. The results highlight the growing academic interest in the research topic, especially in recent years. The results revealed that HTA is a widely known term and represents the reference paradigm for assessment in healthcare technologies. This paper contributes to the field by providing an examination of the current state of the art of HTA research and identifying possible future research directions. This study differs from existing studies because it involved a conceptual analysis of the scientific literature using macro keywords.

Academic Health Centers' configurations, scientific productivity, and impact: Insights from the Italian setting.

Academic Health Centers (AHCs) have an enormous impact on health, society, and national competitiveness. They have a threefold strategic mission and heterogeneous models of governance. Our aim is to investigate how different AHC configurations are associated with research performance. The method we adopted follows two steps. First, we identify organizational configurations through cluster analysis of nine variables. Second, we correlate these configurations to bibliometric measures of research outputs. Findings show that AHCs, that are specialty-focused and not mainly involved in educational activities are more productive and have more research impact than fully integrated and affiliated AHCs. Those AHCs also share secondary contextual features.

Financial configurations of Italian private hospitals: an evolutionary analysis.

Private hospitals are an important pillar in many hybrid systems. In Italy they are bound to grow, but we have little knowledge of how they are coping with financial pressures. We use a configurational approach to determine the relationship between the macroprofiles of Italian private hospitals and their performance. We built a unique dataset with governance and financial statements data of all Italian private hospitals. We use a combination of partial triadic analysis (PTA) and clustering technique to identify both the main explicative financial dimensions and hospital configurations, and trace their evolutionary paths from the beginning of Regional Health Care Turnaround Plans (2008) to 2016. Understanding the evolution of configurations, our study entails also some implications for policy and practice.

The challenge and the future of health care turnaround plans: evidence from the Italian experience.

Over the last two decades, health policy and governance in Italy have undergone decentralisation at the regional level. The central government was expected to play a guiding role in defining minimum care standards and controlling health expenditures at the regional level in order to keep the entire Italian National Health System (INHS) on track. Although health performance trends have been consistent across regions, public health expenditures have been variable and contributed to a cumulative deficit of 38 billion Euros from 2001 to 2010. To address the deficit, the government called for a resolution introducing a partial bail-out plan and later institutionalised a process to facilitate a turnaround. The upturn started with the development of a formal regional turnaround plan that proposed strategic actions to address the structural determinants of costs. The effectiveness of this tool was widely questioned, and many critics suggested that it was focused more on methods to address short-term issues than on the long-term strategic reconfiguration that is required for regional health systems to ultimately address the structural causes of deficits.We propose an interpretative framework to understand the advantages and disadvantages of turnaround plans, and we apply the findings to the development of policy recommendations for the structure, methods, processes and contexts of the implementation of this tool.