Developing a combined quantitative benchmarking system for the performance of local health authorities: The case of the Tuscany Region in Italy

This paper proposes an integrated quantitative benchmarking approach for the measurement of the performance of Local Health Authorities (LHAs). It is based on a sound balanced scorecard approach developed and implemented in the Tuscany Region by the Management and Health Laboratory of Sant’Anna School combined with a bias corrected measure of technical efficiency, estimated using a bootstrap based Data Envelopment Analysis. The empirical results show that the typical LHA in Tuscany experienced 14% bias-corrected inefficiency in 2007. Using correlation analysis and mapping quadrants, the paper shows the relationships among technical efficiency and quality and appropriateness as well as analyses the impact of organizational factors on the performance of LHAs. Finally, this combined benchmarking approach is illustrated as a useful and important managerial tool both for regional and local authorities.