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Health Policy. 2010 May;95(2-3):137-43. doi: 10.1016/j.healthpol.2009.11.011. Epub 2009 Dec 16.

Disinvestment for re-allocation: a process to identify priorities in healthcare.

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Laboratorio Management e Sanità, Scuola Superiore Sant'Anna, piazza Martiri delle Libertà 33, 56127 Pisa, Italy.


Resource scarcity and increasing service demand lead health systems to cope with choices within constrained budgets. The aim of the paper is to describe the study carried out in the Tuscan Health System in Italy on how to set priorities in the disinvestment process for re-allocation. The analysis was based on 2007 data benchmarking of the Tuscan Health System with an impact on the level of resources used. For each indicator, the first step was to estimate the gap between the performance of each Health Authority (HA) and the best performance or the regional average. The second step was to measure this gap in terms of financial value. The results of the analysis demonstrated that, at the regional level, 2-7% of the healthcare budget can be re-allocated if all the institutions achieve the regional average or the best practice. The implications of this study can be useful for policy makers and the HA top management. In the context of resource scarcity, it allows managers to identify the areas where the institutions can achieve a higher level of efficiency without negative effects on quality of care and instead re-allocate resources toward services with more value for patients.

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