“Toward a full decentralization of public regional healthcare systems: an exploratory system dynamic approach to evaluate some socio-economic healthcare performances after the recent reform in Sicily”.

The Italian Healthcare Service, originally managed by the central Government, has been gradually adjusted toward a decentralized model, with ample devolution of legislative, organizational and financial competencies to the regions, now responsible for the creation of an institutional framework where efficiency, efficacy and accountability have to inform the actions of the healthcare operators. In Sicily for decades those principles seem not to have received practical implementation, as the healthcare system has been chronically marked by unsatisfying social and economic performances. Due to the recent financial disequilibria, the central Government pushed the regional one to reform the entire health sector, undertaking a path of recovery and reorganization. The paper is part of a Ph.D project that will analyze the effects of this reform with a System Dynamic approach. For this purpose, a dynamic model, portraying a simplified version of the Sicilian healthcare system, is under construction and calibration. The present work will explore the main features of the reform, also showing, through causal loop diagrams and stock-and-flow structures, the outputs of the modeling activity undertaken up to now. This kind of approach can help to evaluate the impacts of the ongoing reform (trade-offs, delays or failures in goals achievement, possible areas of improvement). Moreover, it could also be useful to stimulate the empowerment of different healthcare actors, encouraging them to adopt a shared vision about what determined the problematic behavior patterns, why some decisions have been taken, and which contribution to the general performance is expected from each responsibility area.