Governance, leadership and management of the health sector and healthcare companies

A.Y. 2021/2022
12
Max ECTS
80
Overall hours
SSD
SECS-P/03 SECS-P/07
Language
Italian
Learning objectives
Students will be introduced to key topics and issues that concern the leading and managing functions within organizations, companies and agencies/institutions operating in the health system and sector. New paradigms that are transforming how health services are planned and delivered will be presented and discussed. Frameworks and logics defining the "new normality" of the health sector will be investigated. Through the course will be also discussed challenges of organizing and managing health services in modern medicine times, the relate devolution of professional and managerial roles, and the scenarios and trajectories that will reshape the short and medium term future of the Italian National Health System (INHS) and sector.
Expected learning outcomes
By the end of the course, participants will be able to: · Understand how health policy and planning are evolving, and the major changes at institutional, polictical and soccietal affecting the INHS and italian health sector; · Contribute to the development of strategic directions, competitive and institutional positioning, in all contexts and working environment they will operate after conclusion of the degree; · Define and design health scenarios useful to envision specific dynamics of the health sector useful to decision-making · Understand and frame most important managerial processes developed within organizations, agencies and companies operating in the health sector: planning, organizing, controllig, decision-making, change, good governance. . Further, through the learning work done with case studies, class discussion, individual and
Pag. 2 di 3group presentation, flipped classes, participants will develop problem-solving capacity, self sense-maling ability and communication and presentation skills.
Course syllabus and organization

Single session

Responsible
More specific information on the delivery modes of training activities for academic year 2021/22 will be provided over the coming months, based on the evolution of the public health situation.
Prerequisites for admission
None
Assessment methods and Criteria
- Mid Term group work 30%
- Written final exam 70%
- Individual assignment pass/fail
- Class attendance is strongly advised.
In your own interest and of your colleagues, please try to observe the following courtesy
rules:
1. Arrive in class on time; do not leave early.
2. Keep your mobiles and laptops off; do not use wireless network emailing in class.
3. Participate fully in class.
4. Pull your weight in group/joint work. Do not free-ride on your colleagues!
5. Hand in assignments on time. Late submissions will be heavily penalized.
6. Enjoy the experience
Public economics
Course syllabus
Through the course, the following topics will be presented and discussed:
1. Introduction: the relationships between health, health care and economy
- Health care as right or as market good
- Allocation and priority choices in the INHS
- Medical and economic rationality
- Individual and collective wellbeing
2. The economic dimension of health systems
- Financing and expenditure in the Italian health system
- A comparison with the EU and OECD countries
- Health care as a national industry
- The interrelationships between health, health care and the economy
3. Principles of economics
- The problem of resource allocation. The production frontier
- Production and exchange of goods in the economic system
- Prices and markets
- The functioning of the economy. The Gross Domestic Product
- Private, public and merit goods
4. The theory of demand
- The elasticity of demand
- From health needs to demand for health services
- Imperfect information and doctor-patient agency relationship
- The supplier-induced demand
- Factors affecting health needs and demand for health care
- The cost of illness. Concentration and persistence of health expenditure
5. Equality and equity in health and health care
- Definitions and measurement
6. The theory of supply
- The supply of health services
- For profit and not-for-profit hospitals
7. The theory of competitive and monopolistic market
- The imperfect health care market
8. Production and costs
- Fixed and variable costs
- Average and marginal costs
- The break-even analysis. Equilibrium of the firm under competition and of a
public enterprise
- Private and social costs
9. The health system: structure, goals and performances
- Sub-systems and health schemes
- Illness risk and risk pooling
- The basic models: free market, voluntary health insurance, social health
insurance, national health system
- The two main health care markets. Public and private dimensions in health care
- The performance of EU and OECD health systems
10. Contract and integrated health systems
- The pro-competitive reforms of the '90s
- Two health care reforms in Italy. The public health enterprise
- ASL and AO: integrated and separate models
- Assessment of a public health enterprises: economic balance, efficiency,
effectiveness and performance
11. Economic evaluation of programmes, technologies and health services
- Components of a health programme. Perspectives of analysis
- Methods of economic evaluation: cost-effectiveness, cost-utility, cost-benefit
analysis
- Critical appraisal of published studies
- Use of economic evaluation for priority setting

Further info concerning the course content will be provided on https://ariel.unimi.it
Teaching methods
The course is intended to provide students with basic economics applied to health services;
therefore a part of teaching will be theoretical, unless participants show a good knowledge
of economics. Exercises and case studies on the topics presented will be carried out and
discussed.
The programme also includes a field work, implemented on a voluntary basis and in small
groups, that will follow the topics covered (e.g. demand, supply, costs, performance, etc.).
Intermediate results will be discussed in the classroom and the final presentation of results
will be evaluated.
Teaching Resources
To supplement the classroom teaching material, the following readings are recommended:

TEXTBOOKS ON HEALTH ECONOMICS (in Italian):
- Dirindin N., Vineis P., Elementi di economia sanitaria, Il Mulino, Bologna, 2004, pp. 228, €
17,00
- Levaggi R., Capri S., Economia sanitaria, F. Angeli, Milano, 2013, pp. 432, € 35,00
- Citoni G., Garofalo G, Servizi sanitari. Economia e management, Esculapio, 2005, pp. 357, €
35,00
- Zangrandi A. (a cura di), Economia e Management per le Professioni sanitarie, McGraw
Hilll, Milano, 2011, € 30,00 pp 358
- Mapelli V., Il sistema sanitario italiano, Il Mulino, Bologna, 2012, pp. 284, € 22,00

TEXTBOOKS ON ECONOMIC EVALUATION (in Italian):
- Drummond MF, Sculpher MJ, Torrance GW, O'Brien BJ, Stoddart GL, Metodi per la
valutazione economica dei programmi sanitari, 3a edizione, Il Pensiero Scientifico Editore, Roma, 2011, pp. 504, € 45,00
- Jefferson T., Demicheli V., Mugford M., La valutazione economica degli interventi sanitari, Il
Pensiero Scientifico, Roma, 2009, pp. 140, € 15,00

With the aim of supporting the students, the Instructor will upload additional materials on
https://ariel.unimi.it
Business administration and Management
Course syllabus
Through the course, the following topics will be presented and discussed:
1. Challenges for the Italian health sector
- New and dominant paradigms in health policy
- Implications for the players operating in the INHS and sector
- System vs. Sector
- Likely and sustainable futures
2. Specificities of public health system and complexity of health organizations
3. Introduction to "corporatization" of health organizations
- Management cycle
- Corporate functions
- Organizational transformations
- New roles
- Career opportunities
4. Introduction to reconfiguration of health sector medical devices and pharma companies
- Development in organizational design
- Development in roles and professions
5. Tools for governance and management of health sector, system, organization
6. "Making things happen"
- Leading the heath organization
- Leading the governmental agency/institution
- Leading in the business environment
7. "Making managers manage"
- Change logics and tools
- Aligning skills, competencies and talent to "big objective"
8. Matching demand and supply in the labour market of health management (MASS boot
training camp)

Further info concerning the course content will be provided on https://ariel.unimi.it
Teaching methods
Sessions will consist of formal lectures and case study discussions. Case studies may be
handed out prior to the lecture in which they will be discussed. Students are expected to
prepare for and take part actively in class discussions. Student presentations are an
essential part of the course. Experts and practitioners will be also invited to share with
class their experience and knowledge. Self-learning will be stimulated.
Teaching Resources
The handbook for both attending and non-attending students is:
F. Lega, Management e leadership dell'azienda sanitaria, EGEA, 2016.

Instructor will upload additional materials on https://ariel.unimi.it
Business administration and Management
SECS-P/07 - BUSINESS ADMINISTRATION AND ACCOUNTING STUDIES - University credits: 6
Lessons: 40 hours
Professor: Lega Federico
Public economics
SECS-P/03 - PUBLIC ECONOMICS - University credits: 6
Lessons: 40 hours
Professor: Mapelli Vittorio
Professor(s)
Reception:
Weekly - plese write to federico.lega@unimi.it
Department of Scienze Biomediche per la Salute - Via Pascal 36