**1. Introduction**

298 Health Management – Different Approaches and Solutions

Travis, P., Bennett, S., Haines, A., Pang, T., Bhutta, Z., Hyder, A.A., Pielemeier, N.R., Mills,

WB (2005). Health Services Delivery – Lessons from Low and Middle-Income Countries

WHO (2004). World report on knowledge for better health: strengthening health systems,

Millennium Development Goals. *Lancet*; 364: 900-06.

WHO Geneva.

Concept Note," David Peters, The World Bank, Washington.

A., Evans T. (2004). Overcoming health-systems constraints to achieve the

A growing number of factors among which rising costs, technological advancements, aging population, health market failure and medical errors, led many industrialized countries to manage their health services and goals through performance measurement (Arah et al, 2003; Kelley & Hurst., 2006; Smith, 2002). In this context it became a commonplace for countries to formally assess the performance of their healthcare system (Mc Loughlin et al., 2001).

Since the 1980s the introduction of "New Public Management" (NPM) principles has promoted a number of reforms in order to drive a more efficient, effective and accountable public sector (Hood, 1995a; Lapsley, 1999; Saltman et al. 2007). OECD countries have applied these principles in different ways with different emphasis (Hood 1995b).

Among the NPM principles, the one asking the public sector to adopt more explicit and measurable standards of performance measurement, has motivated countries to create different performance measurement systems (PMS).

In the Italian health sector, the development of PMS can be traced back to the 90s reforms that introduced managerial tools and devolved the organization and assessment of healthcare services to Regions. This devolution, enforced by the recent federalist reform of 2009, has led Regions to shape their own organizational structures and relationships among health system actors (Censis, 2008; Formez, 2007). As a consequence of these reforms, Italy has now 21 Regional Health Systems with significant differences from each other.

On the basis of these considerations the Italian health sector provides with an interesting scenario in order to detect and analyze the differences and similarities in PMS adopted by the Regional governments.

This chapter attempts to provide a cross sectional analysis of the Italian Regional PMS characteristics using evidences of an empirical study carried out in 2008-2009.
