Abstract Chapter 9

Chapter 9 analyzes the changes occurred in the characteristics, purposes and levels of effectiveness of the planning and control systems (P&C) of public health companies. The latter, following the season of institutional engineering and consolidation of many Regional Healthcare Services, are today characterized by larger dimensions and often radically changed institutional and organizational profiles. In this context, the contribution investigates the organizational position, role and process of integration of the main elements of the P&C (management control system - MCS) package: analytical accounting, budget, reporting, and links with the incentive system. To this end, the chapter proposes an analysis of four business cases invested by merging processes in 2016-2017, placed in geographically diverse contexts: ASST Fatebenefratelli-Sacco (Lombardy), AUSL Toscana Centro, ASL Reggio Emilia, ATS Sardegna. The analysis was conducted through semi-structured interviews with the company managers of P&C systems. The role assigned to P&C is the main differentiating feature of the four companies, varying from the control of traditional control and production of data, to integration with general accounting, health planning and socio-health territorial, the incorporation of operation management. The process of integration of the instruments, on a technical level, appears to be well underway in all the cases analyzed; in some cases, delays in the revision of organizational structures and responsibilities and in the conclusion of trade union agreements were slowed down. On the other hand, some elements emerge that facilitate the adaptation of operating systems to new business realities: the existence of regional indications on the configuration and power supply of the instruments; the use of the same software in the pre-existing companies; the clear definition of the strategic mandate and the tasks assigned to the P&C function. In all cases, the merger became the time to look for a new configuration of the MCS package; it is not yet clear, however, if this new configuration and the long-awaited process of empowerment of the intermediate levels of management can effectively reinforce each other.