I sistemi di management control nella sanità pubblica italiana: dalle strutture verticali ai processi orizzontali

The paper provides a theoretical contribution to public management studies related to public health organizations, starting from the Zappian perspective of organizational economics doctrine. After defining the characteristics of institutional change in the organizational literature, the paper outlines how the management model of public health organizations has evolved. The paper therefore clarifies the variants of the traditional health care organizations in Italy (professional bureau-cracy and jusbureaucracy), noting the reasons for the balance found via the variants in the specialist- functional model. The appropriate changes in the manage-ment control systems to support the transition of organizational models are out-lined. This framework is based on three complementary key value drivers (organization, inter-disciplinarily, technology-intensive). Furthermore, the framework is also aimed at encouraging the evolution of public health organizations toward management by objectives, an approach that is in line with new forms of horizontal inter-organizational coordination based on the process of creating value for the patient.