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The goal of this contribution is to shed light on the benefits for research in health care coming from the use of administrative data, especially in terms of measuring hospitals’ outcomes. The main approaches to health outcome evaluation are reviewed and the possible improvements deriving from the use of administrative data are highlighted. Administrative data may be an essential element in the process of gathering to the public true rankings of health care organizations, reducing the degree of asymmetric information that typically arises in health care. Patients will be more aware of the best institutions, which will induce most of them to demand to be admitted in them, taking into account the costs associated with distance and with the severity of the illness. This in turn may ask for a reorganization of the sector, closing some organizations and expanding others, having as final goal to improve the health status of the population, without income barriers. This is one of the first attempts to provide an overview of the advantages that administrative data may gather in health care.

As testified by its secular history, Catholic Social Teaching is closely bound to the various attempts that have been made at putting it into practice. Today, one of the most interesting ones is that of the enterprises' association Compagnia delle Opere. Particularly in Italy, the Compagnia wants to become an important point of reference for Small and Medium Enterprises, the heart of Italian production system, through a new socioeconomic concept, based on the Subsidiarity Principle and the growth of the nonprofit sector. In many ways, it aims to create an alternative to classical capitalism, also supported by Benedict's XVI recent social encyclical; nevertheless, numerous ambiguities persist.

The purpose of this paper is to propose a practical conceptualization of the balanced scorecard (BSC) to describe the mechanism producing creation of monetary value for hospitals in the territorial context of Lombardy region (Italy).

The authors propose a model‐building strategy that assigns key indicators to key performance areas, and identifies causal relationships between key performance areas. Second, the authors utilize a suitable statistical approach to estimate causal relationships among involved latent variables, taking into account the hierarchical structure of data. Utilizing a suitable data decomposition, the causal model is applied separately to the within data (hospitals) and to the between data (local health agencies).

In the measurement model a new latent construct (medical human capital) was found that resumes the amount of formal training and the performance of surgical staff in hospitals. The estimated causal models reflect the usual directional assumptions, supposed in a typical BSC causal scheme, with some differences. For local health agencies, fruits (financial measures) are strongly related to clinical processes (leaves) for which the medical human capital constitutes its unique trunk. However, for hospitals, fruits (financial measures) are directly linked to clinical processes and Patient Satisfaction.

The main limitations of this study are the lack of new independent data to validate the obtained causal structures and the limited number of indicators that reflect the deficiency of available information in regional administrative archives.

The present study may be useful to guide further efforts which attempt to conceptualize BSC in the health sector. As more information can be made available, other performance indicators can prove to be linked with this structure using the same methodology.

This chapter aims to provide suggestive evidence on how the Lombardy region dealt with the COVID-19 pandemic in 2020 and discuss future challenges for the Lombardy healthcare system. After an introduction to the wide spread of the virus inside the region, we describe the Lombardy health system so the reader may understand the context in which the virus has taken hold so quickly. The pandemic has heavily stressed the system, mainly because Lombardy experienced an excess of hospital admissions. We have considered the increased mortality rate as a proxy of the proper managing of the COVID-19 pandemic. In addition, we describe the process of treating non-COVID patients, such as those affected by acute myocardial infarction (AMI), stroke and oncological diseases. Despite the pandemic, hospitals have been able to guarantee a high level of performance. A discussion of the future evolution of the healthcare system concludes this chapter.

The purpose of this paper is to identify the key performance indicators (KPIs) of vaccine supply chain of Universal Immunization Program (UIP) India, and measure their impact on vaccine supply chain performance improvement, so that results of this study can help the decision makers manage the activity and effectiveness of their resources in order to improve vaccine delivery performance and child immunization coverage.

The 41 KPIs in terms of four dimension of the balanced scorecard (BSC), i.e. financial, customer, internal process and learning and growth have been identified and validated from the literature and expert’s opinions. Further, the impact of internal process and learning and growth performance indicators on the vaccine supply chain performance improvement have been evaluated using two-way assessment. The rankings obtained using two-way assessment are then compared to DEMATEL approach to validate the results.

The results from the analysis reveal that “Enhancement in employee work satisfaction” (LG3=10.08 percent), “Enhancement in professional vaccine supply chain managers and leaders” (LG2 = 6.70 percent) “Improvement in planning and coordination in the supply chain” (LG9 = 6.57 percent) are the three critical performance indicators having maximum impact on vaccine supply chain performance improvement. The decision makers should give priority to these performance indicators to improve delivery performance and immunization coverage.

This study focuses on the improvement in vaccine delivery performance, therefore, analysis and findings can be useful to government immunization programs of India to other developing nations to improve child immunization coverage.

To our knowledge, this paper is first to attempt to provide a direction to improve immunization coverage through vaccine supply chain performance indicators.

In this paper we propose a methodology for the estimation of customer satisfaction conceived as a latent variable specified in the American Customer Satisfaction Index (ACSI) structural model. The current proposal puts forward: the approaches of structural equations, since it involves the dual problem of indeterminacy of the latent scores and the normality assumed; the PLS approach, because of its drawbacks (shown in depth in the paper). The ACSI model will be estimated in a reduced rank regression (RRR) framework, showing that under a non restrictive hypothesis, shared by PLS, the structural model can be viewed as a RRR model between two blocks of manifest variables. Finally, in the paper an application is shown to assess the students’ satisfaction in respect to the service of a big real estate agency, operating in the houses‐to‐let market, in Bologna (Italy) for 2002.

The aim of this paper is the discussion and the dissemination of initiatives promoted by the Lombardy region for the construction of benchmarking systems between regional health structures of care utilizing administrative archives.

The paper focuses on relative effectiveness (specific effect of care on patients) in a benchmarking framework, considering the dimension of sentinel outcomes. From Lombardy Hospital Discharge Cards proxies of sentinel outcomes are identified, defined as “context indicators” useful for a benchmarking analysis.

First, the authors present outcomes and covariates at different levels (patient and healthcare structure) extracted from the Lombardy Hospital Discharge Cards for a benchmarking analysis. Second, empirical results show a consistent quota of outcome variability between structures of care and weak agreement between estimated rankings for context indicators. Finally, a slicing approach is suggested in order to apply an equitable comparison among healthcare structures.

The paper provides regional stakeholders with practical implications regarding available strategies (outcomes, statistical methodology, risk adjustment) for consistent processes of evaluation, in a benchmarking framework, based on existing regional administrative data.

After having presented available information contained in regional archives for a benchmark analysis, empirical results were discussed about context indicators, presenting indications and strategies for a refinement of the approach. From a methodological point of view, the utilization of multilevel models (improving methodological strategies adopted by international agencies) in large administrative databases is proposed.