The Regionalization of the Public Health System and New Governance Models for Healthcare: The Stroke Network Case in Italy

This article describes the outcomes of a 2009 study into the reasons for the regional differences in implementation of “stroke networks” in Italy. Evidence shows that early diagnosis and delivery of treatment in specialized stroke units, including rehabilitation therapy, can reduce the risks of death and disability. Nevertheless, there are significant differences and delays in the implementation of such practices. To understand the reasons for the delays, measures were examined, including decision makers’ agendas, regional budget limitations,organizational delays, structural complexity, competition over scarce resources, power structure differences, and informal practices. This study outlines five main models of management and shows how competition with private hospitals, internal rivalries involving professionals and medical sectors, expenditure restraints, and a lack of well-trained personnel represent the main obstacles to the development and operation of stroke units.