Reform: health care

The Italian National Health Service was established in 1978 as three-tier system, involving State, Regions, USLs (Unità sanitarie locali, Local Health Care Units). The division between the responsibility of determining the general features of health care policy and financing it, on one side (the State), and that of managing services, on the order side (Regions and USLs), was bound to lead to increasing levels of expenditure and large financial deficits. An important reform has been carried out over the last five years, aiming toward a more decentralized system, which, although still public, were based on competition among suppliers and free choice for consumers. We argue that although the reform seems to have been successful in containing public expenditure, it has left some important issues still unresolved: the relationship between patients' freedom of choice and competition among providers, and the definition of a model of rationing the bundle of health services financed by the public sector.     

Suicide by Self‐Administration of a Drug Mixture (Propofol,Midazolam, and Zolpidem) in an Anesthesiologist: The First Case Report in Italy

The authors report an unusual case of suicide of an anesthesiologist, in which the suicide manner and means depend upon the victim's occupation. This is the first case report published in Italy of a death involving propofol and other drugs. The anesthesiologist was found dead with an empty drip still inserted in the hand and another one near his body. Forensic and toxicological findings suggested that the cause of death was a respiratory depression due to a self‐administration of a rapidly infused lethal drug mixture. Analytical drug quantification was performed by gas chromatography‐mass spectrometry. Blood analysis revealed: zolpidem (0.86 μg/mL), propofol (0.30 μg/mL), midazolam (0.08 μg/mL), thiopental (0.03 μg/mL), and amitriptyline (0.07 μg/mL). Adipose tissue and hair analysis suggested a previous and repeated use of these drugs verifying the fact that in Italy recreational abuse of anesthetic and sedative agents in health care practitioners is becoming an increasing problem.     

Centre parties and anti‐system oppositions in polarised systems

This article seeks to show the connection between the ‘positive’ integration of anti‐system oppositions and governmental coalitional strategies in four European polarised democracies (the French Fourth Republic, the Weimar Republic, Finland and Italy). It tests the possibility of a stabilisation of some polarised systems (Finland and Italy) through the extension of co‐operation between anti‐system oppositions and centre parties in government. The aim of this research is therefore to locate some of the factors which can halt the ‘enfeeblement of the centre’ in polarised systems, namely through the ‘conversion’ of at least part of the anti‐system oppositions into loyal or semi‐loyal ones, and the extension of the centre area of the party system.     

Industrial concentration in Europe

The European Union has been trying to achieve its long-term goals through partnerships and cooperation with other like-minded global actors. Africa (through its regional institutional body, the African Union) has been the first and only multilateral entity with which the EU has forged a long-term partnership. Despite its rhetorical language, the Africa--EU Strategic Partnership is unlikely to upgrade the political and economic interaction between the two partners. In the past few years, serious rifts have grown between the EU and its African counterparts concerning trade agreements and development policies. Moreover, new actors have made significant inroads in Africa, providing an alternative to its long-standing dependence on Europe.     

External Pressures and Internal Dynamics in the Institutionalization of Performance-Based Budgeting: An Endless Process?

The well-known practice of performance-based budgeting (PBB) is a relevant component of the New Public Management (NPM) reform agenda and has become widespread, with varying approaches and results across countries. However, its variation within specific countries has remained largely unexplored. This study analyzes three organizations operating within the same context—three ministries in Italy—to contribute to a new understanding of PBB variation by illustrating why the same PBB practice can or cannot be implemented and internalized similarly across these organizations and thus become (or not) fully institutionalized. The study adopts and enriches the institutional approach by extending beyond isomorphic convergence toward PBB and explaining practice variation, linking the interactions between external pressures and internal dynamics at the organizational level to PBB institutionalization. The empirical analysis shows how a lack of alignment between external pressures and internal dynamics contributes to an unfinished and apparently endless process of institutionalization.     

The enabling role of institutional entrepreneurs in the adoption of IPSAS within a transitional economy: The case of Estonia

In the light of neoinstitutional theory and by adopting case study research methodology, this article explains the adoption of International Public Sector Accounting Standards for modernizing public sector accounting in Estonia. This article reveals that the smooth—yet gradual—adoption of International Public Sector Accounting Standards‐compliant accounting systems was enabled by the involvement of powerful actors (i.e., institutional entrepreneurs) with foreign and/or business backgrounds. In addition, the change in public sector accounting in Estonia was facilitated by the developments in its international positioning, characterized by the transition from a Soviet communist to a market economy and subsequent European Union membership and by the absence of past accounting practices, which could potentially hinder the change.     

China’s Structural Power and the Fate of the BCIM Economic Corridor

ABSTRACT

In 2013, China and India officially established an economic corridor (the Bangladesh–China–India–Myanmar Economic Corridor, BCIM-EC) that would cut across Myanmar and Bangladesh. But while the formal process of cooperation among the four countries is in place, many obstacles to its implementation remain at the international, national and local levels. Is meaningful collaboration possible within the BCIM-EC framework? In terms of two dimensions of structural power as conceptualised by Susan Strange, security and trade, China’s structural power in Myanmar is much stronger than India’s. It is therefore likely that this imbalance will prevent the BCIM-EC project, which currently appears to be overshadowed by China’s Belt and Road Initiative, from having a fruitful outcome.