Lack of Good Governance or hazard of consumers e-Health? Evidence through a dynamic outcome based-performance in the Italian healthcare sector about the spread of Measles.

This research aims to analyse the management of the health policies to contain the measles outbreaks in Italy. In particular, this study wants to find out what are the key factors that led to the measles outbreak of 2017 and its previous cyclical trend, analysing the impact of ehealth strategy in the management of the epidemics. Understanding the complexity of this issue will help to evaluate the actual policies of the Italian Ministry of Healthcare and to steer the policy-makers to frame sustainable policies to manage the risk of a measles outbreak. The thesis is structured in four chapters. The first chapter, through a literature review, discusses the evolution of the management of epidemics, with a particular focus on the measles issue, starting from the concepts of inoculation and vaccination up to the recent epidemics and the current surveillance systems regarding public health. The measles issue is studied analysing the historical, normative and social context of the phenomenon. In the end, this analysis leads to formulate the research objective and the research questions. The second chapter introduces the methodological aspects applicable to the context of the management of measles outbreaks in Italy, regarding health performance assessment. In this sense. Starting from a brief consideration on the most used methodologies regarding health performance, the systemic approach is analysed under a dynamic profile through the introduction of the SD (System Dynamics) and DPM (Dynamic Performance Management). Furthermore, some methods for the analysis of vaccination policies for the management of infectious diseases are introduced. After the general discussion of the Italian measles issue, and the analysis of the methodology, the third chapter deals with analysing the measles issue through Dynamic Performance Management (DPM) methodology. In this sense, starting from a conceptual model, a model of DPM has been developed, according to a Dynamic Outcome-Based Performance Management approach. The comprehension of the dynamics, which revolve around the vaccination system, the concerns of the population and the reasons that lead to the rejection of vaccination, is - moreover - fundamental for giving answers and restoring trust in the health system. The DPM approach shows, moreover, as it is possible to overcome a static approach of HTA (Health Technology Assessment), promoting a Dynamic HTA. The outcome of the research, future research directions, as well as the limits of current research, are discussed in the last chapter in the conclusions.