Increasing public healthcare network performance by de‐hospitalization

Gianfranco Ignone (Unità Operativa Complessa di Cardiologia, Presidio Ospedaliero Perrino di Brindisi, Brindisi, Italy)
Giorgio Mossa (Dipartimento di Ingegneria Meccanica e Gestionale (DIMeG), Politecnico di Bari, Bari, Italy)
Giovanni Mummolo (Dipartimento di Ingegneria Meccanica e Gestionale (DIMeG), Politecnico di Bari, Bari, Italy)
Rosa Pilolli (Dipartimento di Ingegneria Meccanica e Gestionale (DIMeG), Politecnico di Bari, Bari, Italy)
Luigi Ranieri (Dipartimento di Ingegneria dell'Innovazione, Università del Salento, Lecce, Italy)

Strategic Outsourcing: An International Journal

ISSN: 1753-8297

Publication date: 15 February 2013



The aim of this paper is to support public decision‐makers in a local healthcare agency (LHA) in evaluating the effects of different de‐hospitalization strategies and the potential for outsourcing clinical services.


The approach adopted is based on the “patient pathway” perspective. Starting from the identification of specific care pathways, all the feasible care paths in a given LHA in Italy are investigated in order to evaluate the practicability of the de‐hospitalization of some phases with a particular focus on co‐ordination of hospitals and territorial services. A heuristic approach based on discrete‐event simulation modelling is proposed. The methodology and the simulation model have been validated with reference to field data derived from a full‐scale case study carried out within a LHA in southern Italy.


The results show where, in terms of care pathways, de‐hospitalization is practicable, valuable in terms of better resource utilization, and eligible for outsourcing. The outsourcing option appears to be more sustainable from a social point of view. It specifies that there would be no dismissal of employees, and that there would be recruitment of specialized workers such as nurses and doctors, employed under more flexible conditions. Savings in overheads would be achieved by means of patient de‐hospitalization.


The existing scientific literature, to the best of the authors' knowledge, deals with patient flow management at the hospital level. However, in the European countries, the public healthcare system is generally organized in terms of the territorially based allocation of service centres. Given the scarcity of public resources, the main difficulty seems to be a mismatch among actions needed to improve territorial and residential care for outsourcing, and the interventions needed to contain hospital costs.



Ignone, G., Mossa, G., Mummolo, G., Pilolli, R. and Ranieri, L. (2013), "Increasing public healthcare network performance by de‐hospitalization", Strategic Outsourcing: An International Journal, Vol. 6 No. 1, pp. 85-107.

Download as .RIS



Emerald Group Publishing Limited

Copyright © 2013, Emerald Group Publishing Limited

Please note you might not have access to this content

You may be able to access this content by login via Shibboleth, Open Athens or with your Emerald account.
If you would like to contact us about accessing this content, click the button and fill out the form.
To rent this content from Deepdyve, please click the button.