How to re-allocate resources within services through data benchmarking: some evidence from the Tuscan Health System.

Background Tuscany Region has implemented a multidimensional system to assess the performance of all Local Health Authorities (LHAs), based on over 130 indicators classified in 6 dimensions in benchmarking. A study was carried out to use the results of the evaluation performance system to support health system decision makers to cope with resources scarcity. Objective To quantify the amount of resources LHAs can re-allocate, taking actions in different sectors, for services with more value for patients. Methods The analysis was based on the data benchmarking of all the indicators of the performance evaluation system with an impact on the level of resources used. For each indicator, the first step was to estimate the gap between the performance of each LHA and the best performance or the regional average. The second step was to measure this gap in terms of financial value. Results The results of the analysis put on evidence that at the regional level 6 to 10 percent of the budget for healthcare (6.100 ml Euros) can be re-allocated if all the institutions achieve the regional average or the best practice. Some LHAs are already efficient but others have large room for improvement: some of them, working on efficiency and appropriatness, can re-allocate up to the 13% of their total costs in services with more value for patients. Policy Implications The implications of this study can be extremely useful for policy makers and the top management of LHAs in a public system that bases its action on cooperation more that competition. Benchmarking makes the system capable to measure the financial impact of different types of actions which can effect efficiency.