Health Outcomes and Patient Empowerment: The Case of Health Budgets in Italy

Scholars claim that the outcomes of health interventions are the products of three factors: the size, the penetration and the sustainability of their effects. Nonetheless, the prevailing biomedical ethic of care engenders a mere ‘fix-it’ approach, which focuses on the clinical treatment of the disease and neglects the role of patients in the process of care. This approach undermines both the size and the penetration of health interventions. From this standpoint, the authors examine different health interventions aimed at improving the size and the penetration of their effects through the empowerment of the patients and their involvement in the provision of care. They are confronted in terms of two different criteria: the ‘intensity’ of the health care co-production and the ‘breadth’ of the health-related needs contemplated. Besides, their outcomes—in terms of health status improvement, patients’ satisfaction and cost savings—have been contrasted. A detailed case study dealing with a pilot project launched in Italy, which involved full-fledged empowerment of the patient, is presented. It is compared with similar initiatives carried out in other European and non-European countries, with the purpose of stressing the peculiarities of the former and explaining the reasons for its success. The findings of this study support the exploratory hypothesis that the higher the intensity of co-production and the wider the breadth of health-related needs considered, the better the outcomes of health interventions.