IDEAS home Printed from
   My bibliography  Save this article

Accordi contrattuali tra produttori e finanziatori in un contesto di programmazione sanitaria


  • Gianluca Fiorentini
  • Cristina Ugolini


During the period 1995-1998, in the Italian NHS, hospital services were provided in a setting characterised by a partial split between purchasers and providers, a DRG-based prospective payment system, and freedom of choice for patients. Managed competition was introduced to reduce prices and improve quality through a better contractual specification of the terms of supply. This paper provides a comparative analysis of the contracts for hospital services between purchasers (AUSLs) and independent public hospitals (AOSPs). The analysis shows that the contractual terms reflected the strong hierarchical control exterted by the Regional Government over the bargaining parties due to the former's responsibility to fund any excess spending. In these highly incomplete contracts, the overall budget was built on a DRG-based mechanism, and financial limits were set on the basis of the historical volumes of production. Due to a lack of productive flexibility, AOSPs systematically violated the budget, and different types of risk-sharing rules were ineffective to that purpose as providers could not be driven out of business. Hence, AUSLs were compelled to purchase hospital services from the local AOSPs at higher prices than those granted by vertically integrated providers. In this context, contracts were used more than to elicit price or quality competition as attempts to control current expenditure and to reduce excess supply. Accordingly, in 1999 most competitive elements of the previous mechanism were replaced by cooperative partnerships between purchasers and producers.

Suggested Citation

  • Gianluca Fiorentini & Cristina Ugolini, 2000. "Accordi contrattuali tra produttori e finanziatori in un contesto di programmazione sanitaria," Politica economica, Società editrice il Mulino, issue 2, pages 169-194.
  • Handle: RePEc:mul:je8794:doi:10.1429/1494:y:2000:i:2:p:169-194

    Download full text from publisher

    File URL:
    Download Restriction: Access to full text is restricted to subscribers

    File URL:
    Download Restriction: no

    As the access to this document is restricted, you may want to search for a different version of it.

    More about this item


    Access and download statistics


    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:mul:je8794:doi:10.1429/1494:y:2000:i:2:p:169-194. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (). General contact details of provider: .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    We have no references for this item. You can help adding them by using this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.