Template-type: ReDIF-Article 1.0 Author-Name: Remo Arduini Title: La "clinical governance" ? una prospettiva innovativa per le aziende ospedaliere? Abstract: In public health care organizations, the doctor is not only important as a provider of medical services but also as the individual that determines the demand of medical services; the doctor is both a participant in the definition of demand for services and the actual person representing the offer of them. Therefore health care organizations must guarantee the possibility for the doctor to act independently. On the other hand this autonomy is limited by the fact that doctors must act within the boundaries of structures that impose rules, hierarchies and adherence to organizational levels. This is the reason why in a hospital structure the doctor does not have the possibility to act in total autonomy. Within the hospital organization conflicts arise that must be either prevented and/or managed trough both coordination and integration of processes. The 2004 reform proposed by minister Sirchia constitutes an answer to the above conflict. It was inspired by the British experience with "clinical governance". Mr. Sirchia?s law proposal creates the so called "clinical coordinator" and provides it with a position in the clinical organization?s top management with the responsibility of definition of policies as well as coordination and controls. He will act as a medical director too. But the creation of the "clinical coordinator" position rather than solve the integration problems, would have generated permanent conflicts at top management level. Luckily the law proposal did not become an act of Parliament; but the problem of finding real solutions to the conflicts arising from the diversity of medical and economic cultures remains. Classification-JEL: I18 Keywords: Note: Pages:5-34 Volume: XL Year: 2010 Issue:1-6 File-URL:http://www.francoangeli.it/riviste/Scheda_Rivista.aspx?IDArticolo=47021&Tipo=Articolo PDF File-Format: text/HTML Handle: RePEc:fan:epepep:v:html10.3280/EP2010-001001 Number: 1 Template-type: ReDIF-Article 1.0 Author-Name: Giuseppe Clerico Title: Scelte pubbliche, efficienza e giustizia distributiva intergenerazionale: ruolo ed effetti del tasso di sconto Abstract: Public projects (to be understood as the set of public choices that affect human behavior and the dynamics of the economic system) can result in an immediate and a future stream of benefits or an immediate flow of benefits with costs occurring in the future. The public choice, therefore, raises both the problem of intergenerational relations and the criterion of fairness (distributive justice) that governs them. The problem arises because, given the non-simultaneity of the costs and benefits of a project, discrepancies may arise in treatment between the generations. The time raises a twofold objective: the pursuit of distributive justice in intergenerational and the need to respect the criterion of intergenerational efficiency level. Closely connected to this dual aim is the problem of the discount rate. As a euro today has a value other than a euro available within a few years the monetary values that accrue in different times must be discounted. The opportunity to use the discount rate raises issues of both fairness and efficiency at both intra-and intergenerational level. Different levels of discount rate implies different burden for different generations. A level is appropriate to distinguish between the problems of fairness from the problems of efficiency. The opportunity of using the discount rate is based on two essential elements: the opportunity cost of capital, and the time preference of the subjects which in turn depends on factors such as impatience and uncertainty. The current evaluation of a public project depends on individual willingness to pay for that project. It follows that the discount of this assessment is similar to the discount of monetary values that ripen at different times. The cost-benefit assessment needs using the discount rate, but the use raises, in particular, the problem of intergenerational fairness. Classification-JEL: D310, H100, H430, H530 Keywords: Note: Pages:35-63 Volume: XL Year: 2010 Issue:1-6 File-URL:http://www.francoangeli.it/riviste/Scheda_Rivista.aspx?IDArticolo=47022&Tipo=Articolo PDF File-Format: text/HTML Handle: RePEc:fan:epepep:v:html10.3280/EP2010-001002 Number: 2 Template-type: ReDIF-Article 1.0 Author-Name: Valeria De Bonis Title: Il dibattito sul federalismo fiscale in Italia tra la riforma tributaria degli anni Settanta e la riforma amministrativa degli anni Novanta Abstract: This paper analyses the scientific and institutional debate on fiscal federalism that took place in Italy in the period between the early Seventies and the early Nineties, when the traditional approach was confronted with the new public choice one, in the context of the changing views on the role of the state. The issue is studied within the set of constraints and opportunities deriving from the European integration process. The proposals put forth in the early Nineties exemplify the emerging model of fiscal federalism both for Europe and for Italy. Classification-JEL: H10, H77, H87 Keywords: Note: Pages:65-81 Volume: XL Year: 2010 Issue:1-6 File-URL:http://www.francoangeli.it/riviste/Scheda_Rivista.aspx?IDArticolo=47023&Tipo=Articolo PDF File-Format: text/HTML Handle: RePEc:fan:epepep:v:html10.3280/EP2010-001003 Number: 3 Template-type: ReDIF-Article 1.0 Author-Name: Fabio Fiorillo Author-Name: Lorenzo Robotti Author-Name: Francesca Severini Title: Standard di spesa e di entrata nella Legge Delega sul federalismo fiscale. Un?analisi con un modello CGE Abstract: The Law 42/09 represents an important step towards fiscal federalism in Italy. In particular, the Law places its foundation on the principles of territoriality, fiscal autonomy and fiscal equalization in order to abandon the criterion of historical expenditure in favor of ?standard costs?. A standard level of services must be provided by the local governments which must finance the expenditures mainly with their own tax revenues. In case the revenues are not adequate to cover the ?standard? financial needs, the central government intervenes with equalization transfers. The definition of ?standard criteria? therefore represents a crucial phase in the whole reforming process. The amount of central government transfers in fact depends on the flexibility of these criteria. Since the law gives very few indications on how to calculate the ?standard costs/revenues?, in this work we propose some alternative evaluations of these and assess the impact that different approaches can have on the central and local budgets using a CGE (Computable General Equilibrium) model based on a bi-regional SAM (Social Accounting Matrix) for Italy for 2003. Classification-JEL: H72, H77, C68 Keywords: Note: Pages:83-104 Volume: XL Year: 2010 Issue:1-6 File-URL:http://www.francoangeli.it/riviste/Scheda_Rivista.aspx?IDArticolo=47024&Tipo=Articolo PDF File-Format: text/HTML Handle: RePEc:fan:epepep:v:html10.3280/EP2010-001004 Number: 4 Template-type: ReDIF-Article 1.0 Author-Name: Leonzio Rizzo Author-Name: Laura Bertin Title: Simulazione finanziaria della Legge delega 42/2009: una proposta di riparto e prime valutazioni Abstract: Italy has recently approved a law (n. 42/2009) implying a strong federal reform of the State. The law regulates the allocation of fiscal power to regions and municipalities and introduces the criteria of standard expenditure and standard cost which should be adopted in the allocation of the federal transfers. The paper contains a simulation of the new financial system regarding either primary expenditures (health, social assistance and school), or secondary expenditures. More in detail the simulation shows that primary expenditure, about 116 billion euros, can be financed through 84.95% of the value added tax and a 3.81% regional tax rate on income. As far as it concerns secondary expenditure (6.7 billion euros) results show that the South of Italy will receive less money with respect to the status-quo provision, whatever the chosen equalization level. Classification-JEL: H24 H25 H71 H72 Keywords: Note: Pages:105-125 Volume: XL Year: 2010 Issue:1-6 File-URL:http://www.francoangeli.it/riviste/Scheda_Rivista.aspx?IDArticolo=47025&Tipo=Articolo PDF File-Format: text/HTML Handle: RePEc:fan:epepep:v:html10.3280/EP2010-001005 Number: 5 Template-type: ReDIF-Article 1.0 Author-Name: Davide Gualerzi Title: Distretti industriali, nuove politiche territoriali e programmazione Abstract: The essay focuses on local development and governance. It examines the questions posed by the evolution of industrial districts and the new policy for local development, the so-called Instruments for Local Development. The analysis highlights a complex and contradictory relationship between the theory of local development, and in particular the notion of Marshallian Industrial District, and the new policy for local and regional development. Calling the new conceptual framework and legislation ?negotiated development planning? engenders a fundamental ambiguity. It suggests a sort of continuity with the previous national policy of economic planning, but is instead defining a fundamentally different approach to government intervention in the economy. Classification-JEL: R1, R5, H1, H7 Keywords: Note: Pages:127-157 Volume: XL Year: 2010 Issue:1-6 File-URL:http://www.francoangeli.it/riviste/Scheda_Rivista.aspx?IDArticolo=47026&Tipo=Articolo PDF File-Format: text/HTML Handle: RePEc:fan:epepep:v:html10.3280/EP2010-001006 Number: 6 Template-type: ReDIF-Article 1.0 Author-Name: Giulia Bianchi Title: Un crocevia di distretti: la realt? economica della provincia di Lucca Abstract: Interest in the ?district? form arose, in Italy, in the context of the debate on the role of small businesses in the Italian and international economy, and intensified during the decade from the mid-1960s to the mid-1970s, when the increasing efficiency of new types of industrialization began to make itself felt. Attention focused on the industrial district as an organizational model of systems characterized by numerous local small and medium-sized businesses capable of offsetting the disadvantage of the smaller production scale by developing a system of external economies. Such businesses were thus able to manage complex processes of decomposition/integration of the production cycle through units specialized in individual stages of production within a social context that could absorb the impact of pronounced division of labour. The potential of the district prompted observers not only to endeavour to identify industrial districts within the Italian economic system, but also to analyse their functioning in order to determine their characteristics in terms of efficiency and competitiveness on local, domestic and international markets. This paper, set within the above-described perspective, aims to analyse the Tuscan district system as an example of a flexible and lean specialisation, with particular reference to the Province of Lucca, taking into account the background of change, evolution and downturns that influenced the Italian economy from the first oil crisis (1973) up to the Treaty of Maastricht (1992). Additionally, emphasis is placed on a comparison with the interpretive model proposed by Giacomo Becattini, whose assessment is shown to succeed in encompassing the ongoing economic transformations and is particularly effective in depicting the specificity of the Tuscan case, destined to survive the pressures of international competition. In the present author?s view the district, far from constituting a recipe valid exclusively on a local scale and during expansionary phases, represents an effective answer to a scenario increasingly - and more and more intensely - affected by economic transformations that can have a major impact. Classification-JEL: B31, L23, O18 Keywords: Note: Pages:157-188 Volume: XL Year: 2010 Issue:1-6 File-URL:http://www.francoangeli.it/riviste/Scheda_Rivista.aspx?IDArticolo=47027&Tipo=Articolo PDF File-Format: text/HTML Handle: RePEc:fan:epepep:v:html10.3280/EP2010-001007 Number: 7 Template-type: ReDIF-Article 1.0 Author-Name: Arnstein Aassve Author-Name: Maria Grazia Pazienza Author-Name: Chiara Rapallini Title: Family taxation and labour market participation incentives in Italy Abstract: The potential implications of using the family as opposed to the individual as the unit of taxation are not clear. This applies both to work incentives and distributional outcomes. In this paper we evaluate the effects of a hypothetical reform of Italian income taxation both on labour supply incentives and on redistribution of income between families with different composition and income levels. In particular, we analyze the potential effects of a shift from the current system of individual taxation to a system of family taxation similar to the French family-splitting approach by implementing a tax-benefit model. Based on data from the Bank of Italy Survey of Household Income and Wealth, our simulations show a reduction in the degree of progressivity and a disincentive for the labour supply of additional earners within the family. Classification-JEL: H24, H31, J08, J16 Keywords: Note: Pages:189-217 Volume: XL Year: 2010 Issue:1-6 File-URL:http://www.francoangeli.it/riviste/Scheda_Rivista.aspx?IDArticolo=47028&Tipo=Articolo PDF File-Format: text/HTML Handle: RePEc:fan:epepep:v:html10.3280/EP2010-001008 Number: 8 Template-type: ReDIF-Article 1.0 Author-Name: Gian Maria Bernareggi Title: La perequazione per gli effetti della mobilit? delle persone sulle finanze dei governi locali Abstract: The compliance with the ?principle of fiscal equivalence?, i.e. the coincidence between the areas of the economic and the political jurisdiction, is a basic requirement for the efficient provision of public services by a local government. The mobility of people is an important factor preventing this requirement from being met and generating a serious case of externality: as a result of mobility, indeed, many people come to consume the services provided by a given local government (e.g. the central municipality of a metropolitan area), although they belong to other political jurisdictions, in which they are voters and taxpayers. From the distributional viewpoint this implies an additional burden on the budget of the municipality in question, and ultimately on the finances of its resident citizens. The idea of devising some way to prevent such burden from arising seems to deserve a great deal of attention. This paper tries firstly to provide an outline of the inefficiencies generated by the mobility of people in the framework of a decentralized state, and in the second place some suggestions about the use of the Italian local revenue schemes (taxes, public prices and grants) - both existing and envisaged in the current project of reform - to meet the demand for equalization arising from the distributional outcome of such inefficiencies. Classification-JEL: H23, H77 Keywords: Note: Pages:219-228 Volume: XL Year: 2010 Issue:1-6 File-URL:http://www.francoangeli.it/riviste/Scheda_Rivista.aspx?IDArticolo=47029&Tipo=Articolo PDF File-Format: text/HTML Handle: RePEc:fan:epepep:v:html10.3280/EP2010-001009 Number: 9 Template-type: ReDIF-Article 1.0 Author-Name: Matteo Ferraris Title: L?Environmental Kuznets Curve nel settore dei rifiuti solidi urbani Abstract: This paper provides a specific application of the Environmental Kuznets Curve (EKC) theory in order to explain the correlation between income and household waste generation. The model highlights an inverted U-shaped path of income-refuse relationship that verifies the existence of EKC depending on the effort of household recycling and consumption. The existence of delinking can derive by income and other socio economic variables that affect the shape of the curve. This model would be a particular application of the theory of delinking with the intent to be empirically implemented. Classification-JEL: C61, Q38, Q53, Q56 Keywords: Note: Pages:229-254 Volume: XL Year: 2010 Issue:1-6 File-URL:http://www.francoangeli.it/riviste/Scheda_Rivista.aspx?IDArticolo=47030&Tipo=Articolo PDF File-Format: text/HTML Handle: RePEc:fan:epepep:v:html10.3280/EP2010-001010 Number: 10 Template-type: ReDIF-Article 1.0 Author-Name: Giorgio Ragazzi Title: Tariffe autostradali: criteri di regolazione e il caso italiano Abstract: The design and regulation of highway tariffs may be quite different depending upon the objectives pursued by the State. If the aim is to protect consumers, tariffs should be tied to the concessionaire?s profit and revised frequently. Instead, fixing the tariff in advance for the entire period of the concession is a better solution if the State?s purpose is to maximize the sum obtained from assigning the concession. Features and merits of the two regulatory systems are discussed, including the problems raised by new investments and unexpected events. The price cap appears to be an intermediate solution which fails however to promote productivity and cost reductions, while making regulation more difficult. In the light of the above, the paper describes the evolution of tariff regulation in Italy, from the origin to present time. Classification-JEL: D42, L43, L51, L92. Keywords: Note: Pages:255-278 Volume: XL Year: 2010 Issue:1-6 File-URL:http://www.francoangeli.it/riviste/Scheda_Rivista.aspx?IDArticolo=47031&Tipo=Articolo PDF File-Format: text/HTML Handle: RePEc:fan:epepep:v:html10.3280/EP2010-001011 Number: 11 Template-type: ReDIF-Article 1.0 Author-Name: Giovanni Pitti Author-Name: Vito Pipitone Author-Name: Giovanni Fultanelli Author-Name: Mario Allegra Title: La domanda di formazione universitaria in Italia Abstract: Over the last decade the Italian university system has been subject to a remarkable reform. The number of courses has increased over time; registrations of new students have been rising more than 13 per cent, despite the Italian unemployment rate of graduates remains above the European average. In this new context, characterized by a growing competitive pressure, this paper tries to understand which today are the main determinants in the demand for academic education in Italy. For this purpose, we use data collected from a national survey by ITD-CNR in the first half of 2008, by means of a web questionnaire (consisting of 44 questions) filled in by students attending their high school final year. These data have been used in order to estimate two binomial logit models, which reveal that inertial factors are the main determinants of the demand for academic education in Italy, both for those students aimed to certainly continue their career, and for those who are irresolute. Families? social and cultural background seems relevant for resolute students, whereas it is not much significant for undecided students. Students? individual skills modestly affect the demand for academic education from students aimed to continue their career, whereas individual skills seem to be very relevant for more perplexed ones. Finally, the economic constraints show an absolute lack of statistic relevance. Classification-JEL: A23, I20 Keywords: Note: Pages:279-301 Volume: XL Year: 2010 Issue:1-6 File-URL:http://www.francoangeli.it/riviste/Scheda_Rivista.aspx?IDArticolo=47032&Tipo=Articolo PDF File-Format: text/HTML Handle: RePEc:fan:epepep:v:html10.3280/EP2010-001012 Number: 12 Template-type: ReDIF-Article 1.0 Author-Name: n.d. Title: Schede bibliografiche Abstract: Classification-JEL: Keywords: Note: Pages:303-309 Volume: XL Year: 2010 Issue:1-6 File-URL:http://www.francoangeli.it/riviste/Scheda_Rivista.aspx?IDArticolo=47033&Tipo=Articolo PDF File-Format: text/HTML Handle: RePEc:fan:epepep:v:html10.3280/EP2010-001013 Number: 13 Template-type: ReDIF-Article 1.0 Author-Name: n.d. Title: Spoglio riviste Abstract: Classification-JEL: Keywords: Note: Pages:310-317 Volume: XL Year: 2010 Issue:1-6 File-URL:http://www.francoangeli.it/riviste/Scheda_Rivista.aspx?IDArticolo=47034&Tipo=Articolo PDF File-Format: text/HTML Handle: RePEc:fan:epepep:v:html10.3280/EP2010-001014 Number: 14