Are Public Health Authorities Able to “Steer” rather than “Row”? An Empirical Analysis in the Italian NHS

The nature of Local Health Authorities (LHA) in the Italian NHS has been deeply reformed during the 1990's by New Public Management reforms introducing decentralization, quasi-market, and managerialism. These reforms implied that the main role of LHAs is to govern the delivery of health services in their area (steer) rather than only directly providing services (row). After more than 15 years from these reforms of Italian healthcare we describe how much the steering vs. rowing dichotomy made an impact on LHAs activity, through an analysis of the management control systems they set up for themselves and the subsequent qualitative analysis of the opinions that a diverse group of managers expressed during eight days of group discussion. Results show that managers of Italian LHAs tend to perceive their steering role as impossible to play and focus on direct delivery, leaving therefore ungoverned a significant part of the services offered to residents. NPM, therefore, was able to influence the reform of Italian health care, but, as suggested by a postmodernist-inspired interpretation, left managers with change based on inconsistent assumptions, instead of actionable ideas to manage the change process