Healthcare Management Roma

The course is aimed to provide students the quantitative dimension of health through the principles and methods of modern epidemiology in order to make them able to design and carry out epidemiological studies, to correctly read them and interpret data. Furthermore, the course will give some insights into specific issues of applied epidemiology.

1. Introduction to epidemiology

• Definition and scope of epidemiology,
• Epidemiology and public health;
• Managerial epidemiology
• Determinants of health
  2. Measures of occurrence: main concepts
• Proportion and ratio,
• Prevalence and incidence;
  3. Measures of association
• Absolute measures,
• Relative measures,
• Attributable and impact measures;
  4. Principles of study design
• Case-control studies: aims, design and conduction, limits and strengths,
• Cross-sectional studies and ecological studies: aims, design and conduction, limits and strengths,
• Cohort studies: aims, design and conduction, limits and strengths,
• Experimental trials and quasi experimental studies: aims, design and conduction, limits and strengths,
  5. Bias
  6. Confounding and effect modification: main concepts
• Analysis of confounders and effect modifiers;
  7. Standardization
  8. Systematic review and meta-analysis
  9. Exposure assessment
  10. Study of an epidemics
• Focus on infectious and chronic diseases
  11. Evaluation of screenings, diagnostic tests and study results.
  12. Epidemiology in Continuous Quality Improvement and perfomance evaluation in health settings
  At the end of the course students should:
  1. have acquired the knowledge and understanding of the main measures of occurrence that concern the health of the populations, the health risk of the populations and the association measures that link the exposure to the effect of population health;
  2. be able to know how to read and interpret epidemiological studies, meta-analysis, epidemiological reports, they should have acquired the skill to interpret the documents drawn up by the main research institutes with critical analysis of the results;
  3. have developed useful skills to independently make choices on the use of measures to be used in the epidemiological field;
  4. know how to deal with issues concerning the quantitative aspects of population health;
  5. have acquired a rigorous and essential language that allows them to communicate clearly and effectively the knowledge acquired in the epidemiological field
  The format of this course is a combination of lectures, case discussions, and readings. We will employ the following teaching methods:
  (a) Readings from textbooks: To provide basic structure, concepts and techniques.
  (b) Readings from journals: To augment the textbooks and provide more rigorous intellectual foundation.
  (c) Lectures/Classes/Discussions: To create a coherent framework of studying the source material; to give students a chance to ask questions and clarify their understanding.
  (d) Case studies: To apply what has been learnt to real life situations.
  Active student participation is essential in the classes. In the classes, the lecturer will introduce the topic/case/experiment/exercise and lead the discussion. Students are encouraged to present pre-assigned material and lead part of the discussion in the class group. Pre-assigned reading of cases and exercises is essential.
  Practicals
  How Epidemiology can contirbute towards change management and improvement scince, respectively.
  Active student participation is essential in the classes. In the classes, the lecturer will introduce the topic/case/experiment/exercise and lead the discussion. Pre-assigned reading of cases and exercises is essential: students are encouraged to self learning, to present pre-assigned material and lead part of the discussion in the class group.
  Practicals and group activities.

There are no intermediate tests.
The final mark will be based on a written test through multiple choice items and open ended questions investigating the main course contents. Evaluations are expressed in 30/30.
All the other details concerning the exam procedures will be given out by each Lecturer at the beginning of the course.

Katz DL, Elmore JG, Wild DMG, Lucan SC. Jekel’s Epidemiology, Biostatistics, Preventive Medicine, and Public Health. Elsevier; 2014.
Fletcher RH, Fletcher SW, Fletcher GS. Clinical Epidemiology: The Essentials. LWW; 2012.
Rothman KJ. Epidemiology: An Introduction. Oxford University Press; 2012

Upon completion of the first module, students are expected to:

• Have learned the primary principles and methods of financial accounting and be able to apply them to the recording of transactions and creation financial statements.
• Be able to evaluate financial reports and make recommendations to internal and external users.
• Analyze how financial statement elements (assets, liabilities, equities, revenues, and expenses) are used in communicating information.
• Prepare accurate financial statements.
• Explain why judgment and interpretation are required to analyze, report, and use financial data.
• Have a proven ability to analyze, interpret, and evaluate financial statements for the purpose of understanding an organization’s operating and financial performance and making decisions regarding the provision of capital.
• Have an appreciation of the larger context of financial reporting (beyond rules and procedures).
  Upon completion of the second module, students are expected to have the requisite knowledge and competency to apply the following cost accounting tools and techniques:
• Knowledge of the contents of the IAS 1 and more specifically of the Balance Sheet and Income Statement structure
• Analyzing cost/volume/profit relationships by healthcare product or service.
• Conducting break-even analysis.
• Implementing the activity-based costing technique.
• Overview of the budgeting process.
• Analyzing annual economic and financial performance of companies belonging to the pharmaceutical industry.
• Forecasting financial, operational results and planning for the necessary corrective actions to improve performance, both in the short and long- term.

The first module will cover the following content (for further details see Appendix A on page 3 and 4.)

• Introduction and Fundamentals of Financial Accounting (Accounting as a decision-making tool, the accounting equation, the transaction analysis, the adjustment and closing process, construction of financial statements).
• Ability to read key Financial Statements.
• The relevance of Cash Flow Statement, the Auditors’ Report, the notes to the Financial Statements.
• The Investments and Consolidated Financial Statements
• Financial Statement Analysis using key financial ratios.
• Managing the Revenue Cycle in the Healthcare Organizations.
  The second module will cover the following content:
• Managerial Accounting Basics & Cost-Volume-Profit Analysis.
• Overheads Cost Allocation and Activity Based Costing (TDABC).
• Cost calculation
• Operating Budgets and Financial Budgets overview.
• Performance analysis, financial and economic equilibrium
  Students are expected to make an effort to get familiar with the assigned readings prior to the relevant class session as well as keeping up with the homework throughout the duration of the course.
  Class participation is particularly important. Students will not receive participation credit solely for attending class. Active participation includes: responding to questions, being engaged during class discussion, and keeping a professional and respectful behavior at all times in the classroom.
  The second module builds on fundamentals of financial accounting concepts and financial statement analysis tools to expand students’ competencies and skill sets for managing healthcare costs and strategic decision-making. Students will focus on management accounting tools and techniques. Through real case studies, students will learn how to interprete, analysis and forecast costs and revenues in a variety of organizational settings, such as managed care organizations, multi-specialty medical groups, and pharmaceutical companies. The aim is to provide the cost management tools and techniques to improve efficiency (cost per unit) and effectiveness (goal achievement). The takeaways will be cost analysis techniques that can be used by healthcare managers to improve organizational performance, both in the short and long- term.

The final exam is 120 (2h) minutes long.
Attending students will earn their grade based on the following activities:
Final Exam (written) 100%

First module:

• Financial Accounting, 8th Global Edition, Libby, R., Libby, P.A., Short, D.A., MaGrawHill Education, On-line educational material.
• Healthcare Finance: An Introduction to Accounting and Financial Management, Gapenski, Louis C., 6th Edition, AUPHA Press/Health Administration Press, 2016.
  Second module:
• Gapenski, Louis C., Healthcare Finance: An Introduction to Accounting and Financial Management, 6th Edition, AUPHA Press/Health Administration Press, 2016.
• Pink, George H., and Paula H. Song, Gapenski’s Cases in Healthcare Finance, 6th Edition, AUPHA Press/Health Administration Press, 2018.

Health economics is a growing field of studies in economics concerned with the use of economic concepts to analyze issues related to health and healthcare. The goal of this course is to discuss selected topics within this field which are of utmost relevance for the management of healthcare organizations. The course will cover both micro- and macroeconomic issues. At the macro level, attention will be paid first to explaining cross country variation in health spending, with a particular emphasis on the role of productivity and the role of technology and innovation. At the micro level, the focus will be on the market for hospital services, which still represent about half of the healthcare spending in many countries. On the demand side, the course will analyze the choice of patients and the importance of information and networks. On the supply side, the course will focus on organizational design: at the firm level, discussing the role of not-for-profit hospitals as compared to physicians’ cooperative, for-profit clinics, public hospitals; at the market level, analyzing the quasi-market model and the role of incentives provided by different payment systems; at the sub-national level, providing a discussion of the implications of federalism and decentralization. Market outcomes will be finally considered in the light of inefficiency in spending and inappropriateness in the services provided. The discussion for all the topics will couple theoretical arguments with the analysis of real cases useful for the management of healthcare organizations.
After the course the student:
Will have knowledge of the determinants of healthcare spending and their role in explaining the observed evolution of public and private expenditure.
Will have knowledge of the economic arguments relevant for the analysis of the demand and the supply of hospital services.
Will be able to apply the knowledge acquired during the course for critically discussing real world cases related to patients’ choice, the organization of hospitals, the organization of the market for hospital services, the decentralization of healthcare regulation to sub-national governments.
Will be able to apply the knowledge acquired during the course to evaluate the efficiency and the inappropriateness of healthcare provision at different levels of aggregation.
Will be able to correctly interpret the outputs of empirical analyses and to discuss the use of appropriate statistical tools.
Will be able to use economic language and concepts in their analysis and reports.

The course is designed as an advanced course in health economics for students interested in becoming professional managers in the healthcare industry. The program is divided in four broad parts:
Part I: Understanding healthcare spending
The economic approach to the analysis of health and healthcare

• Inequalities in healthy life years across countries
  The determinants of healthcare spending
• Observing the dynamics of expenditure
• The role of innovation and technology
  Part II: The demand side of the market for hospital care
  The traditional approaches
• The Grossman model: health shocks and the demand for care
  Information and networks
• Availability of information and patients’ networks
• The quality of care
  Part III: The supply side of the market for hospital care
  The hospital as a firm
• Not-for-profit providers
• Incomplete contracts and a theory of the ownership of the firm
• Mixed oligopolies and beyond
  The hospital as a key market player
• Incentives in the quasi-market model
• The behavior of different types of providers, the role of competition and of information provided to prospective patients
  Decentralization and fiscal federalism
• The regulation of hospitals at the sub-national level
• The differences across sub-national systems
  Part IV: Inefficiency and inappropriateness
  How to evaluate outcomes
• Methodologies to assess inefficiency and inappropriateness
• DEA and stochastic frontiers
  Case studies
• De-hospitalization
• C-sections
  Lectures and discussion of case studies.

Evaluation is based only on a written exam lasting 60 minutes. The exam is made of three sections. Section 1 comprises 10 multiple choice questions on basic concepts discussed during the course. Each correct answer is worth 1 point; each wrong answer provides a penalty of 0.25 points. Sections 2 and 3 are open questions and are thought to test the ability of students to apply the knowledge acquired during the course and to communicate using key economic concepts what they have learned. In marking exams, instructors will evaluate the completeness and accuracy in the answers.

Each topic is covered by a list of selected references (mostly scientific journal articles) that will be provided by instructors and discussed during the lectures. Additional readings will be taken also from:
B.H. Baltagi-F. Moscone (eds.) (2018), Health Econometrics, Contributions to Economic Analysis, Emerald Publishing.
Costa-Font, J., Turati, G., Batinti, A. (2020). The Political Economy of Health and Healthcare: The Rise of the Patient Citizen. Cambridge: Cambridge University Press.
S. Glied-P.C. Smith (eds.) (2011), Oxford Handbook of Health Economics, OUP.

Healthcare organizations are characterized by the central role of human capital in determining quality of care and financial performance. The course aims at providing students with a good knowledge of HRM processes and tools, with a specific focus on their implementation in the healthcare sector. The objective of the course is to develop both theoretical knowledge and practical skills connected to some of the most effective HRM tools used in complex organizations. Moreover, it is aimed at understanding the ways in which innovation affects the health care sector and in particular the workforce, and how it can best be managed.
After this course, students will have an extensive knowledge of the role of the HRM function within healthcare organizations and will be able to match a number of HRM tools and procedures to the function’s (and organization’s) strategy. He/she will be able to assess the “maturity” of HRM functions and be aware of the coherence between its objectives and its actions. Moreover, students will simulate the use of tools aimed at managing competencies and driving performance, thereby acquiring practical ability in concrete and “real-life” situations. Students will be invited to develop HRM strategies and present them to an audience, thereby developing their communication and persuasion skills.

The course is structured into two parts:
Part I (Prof. Federica Morandi)
Introduction; From strategy to people; Medical management and clinical leadership; Assessing jobs, persons and performance; Qualitative and quantitative methods; Pay for performance in medicine; What is a “competence model”?; From job families to professional roles; New competencies for HC professionals: team work; Organizational change; the role of individual.
Final presentations and closing remarks.
Part II (Prof. Magdalene Rosenmoeller)
A complex sector and complex care organizations; The Health Sector and the (Changing) Role of Professionals; HHRR Policy: Needs, Strategy and Planning; The European Context for Health Professionals; Knowledge Management; Continuous Education / Role Professional Journals; Realizing the Technology Revolution in Health Care; IT Technologies: changing paradigm, changed skills set; Integrated Care: Implementation of Innovation; Integrated Care changing role for HHRR; Managing for Quality; Commit to Excellence / Employee Satisfaction;The HHRR Managers Tasks; Career Development – Professional Growth; Leadership in Innovation and Creativity; Bases of Leadership / Clinical Leadership; Creative Teams / Design Thinking; Report Presentations. Conclusions Wrap Up.
Short academic lectures are sided with case study discussions, interactive sessions and laboratories. Regarding case studies, students are asked to read assigned documents in advance, before lessons. Students are also asked to work in groups of 5-6 people and to prepare case discussions of about 30 minutes.
Ten hours of the course are dedicated to a specific laboratory in which students, organized in groups (5-6 people), will have the chance to design job profiles under the guidance of the teacher. Groups are suggested to work during free time and will provide a formal power point presentation.

Students can chose between a different methods.
Studens who join the class activities (laboratory and working groups).
Output laboratory 30 points (1/3 of the total mark), Output working group 30 points (1/3 of the total mark)
Multiple choice questions 30 points (1/3 of the total mark).
The final grade is given by the mean of the three grades assigned.
Students who not join class activities:
Written test made up of open ended 30 points (2/3 of the total mark) and multiple choice questions 30 points (1/3 of the total mark).
The final grade is given by the weighted average of the two grades assigned.
During the first lesson students will be asked to decide to join or not the class activities. Once decided the option it won’t be possible a change.
All students are asked to study all the material used in class as well as to study Crawshaw J, Budhwar P, Davis A. Human Resource Management Strategic and International Perspectives, Sage, London (2019) [Chapters 1, 2, 7, 9, 10, 11, 14].

References
Crawshaw J, Budhwar P, Davis A. Human Resource Management Strategic and International Perspectives, Sage, London (2019) [Chapters 1, 2, 7, 9, 10, 11, 14]
“Characteristics & Qualities of a Personnel Manager”, Bob Kelly, Demand Media
“The Role of HR Manager in Health Care”, Alejandro Russell, Demand Media
Case Study HBS: “Development and Promotion at North Atlantic Hospital”
Doctors and managers: a problem without a solution? (Bmj n. 326, 2003)
What doctors and managers can learn from each other? A lot (Bmj n. 326, 2003)
Case study HBS: Hospital Clínic de Barcelona
Case Study HBS: “Performance Management at Vitality Health Enterprises, Inc”
“Successes and Failures of Pay for Performance in the United Kingdom”, NEJM 2014.
“Allied Health Competency Model”
“Job families and other taxonomies”
Four Habits of High-Value HealthCare Organizations, R. Bohmer, NEJM, 2011
Assessing future health workforce needs. Gilles Dussault et al. Policy Brief, 2010
Action Plan for the EU Health Workforce, EC, SWD(2012) 93 final
Perspective on the Professional Qualification Directive. Eurohealth, 17,4 2011
HBS Intermountain Health Care (2013)
IESE P1102 EN - TMC – Telemedicine Clinic
IESE P1148E Innovating in the Basque Country. Moving to Chronic Care
Think integration, think workforce: Three steps to workforce integration, Centre for Workforce Intelligence, 2013
Why Hospitals don’t learn from Failures, ATucker et al Californian Rev.Management 2003
10 Free (Or Very Inexpensive) Ways To Engage Staff, Quint Studer
Chapter 8 & 9 Recruitment, Interviewing, and Selection Strategies / Maximizing Performance Management and Evaluation. JE Pynes - Human Resources Management for Health Care Organizations: A Strategic Approach. Jossey Bass 2012
Case Pina Bausch: Leadership as collective Genius (ESMT 412-0132-1)
NEJM, Leading Clinicians and Clinicians Leading, R. Bohmer, 2013
Leading Teams (MSH Managers Who Lead, 2008)
Further articles, case studies and book chapters will be provided and shared through Blackboard.

Building on strategic management, innovation and entrepreneurship, this course aims to provide an understanding of the trends and dynamics related to the management of innovation in the healthcare industry.
More specifically, the course will present students with frameworks and tools offered by multiple perspectives, with the aim of offering a heterogeneous set of the theoretical and practical models. Participants will apply such frameworks and tools to simulated and real case scenarios, to better understand the characteristics of managing innovation in healthcare, life-sciences and social services organizations (e.g. pharmaceutical companies, biotech firms, medical devices). The course will include the latest trends leading to digital transformation and sustainability of companies, sectors and healthcare industry.
By the end of the course, students will be able to:

• identify and interpret the main challenges faced by healthcare, life-sciences and social services organizations in the current competitive landscape;
• assess what are the main tools and skills necessary to adopt the innovation and how such organizations implement innovation models;
• understand the technological, human, economic, organizational, social and other dimensions of innovation;
• demonstrate operational knowledge of the tools and models explained during the course and apply them to real world contexts (e.g., private firms or public hospitals);
• appreciate the relevance of managerial and innovative solutions adopted by healthcare, life-sciences and social services organizations;
• develop a strategic innovation and entrepreneurial mindset to innovate in healthcare.

The course is organized in 3 modules.
The first module (Module I) is about the main issues of innovation and R&D management in the healthcare sector (e.g., pharmaceutical companies, biotech firms, medical devices). It will focus first on the basics of innovation and technology management, applied to healthcare, and then on emerging health technologies, their development and diffusion. Finally, it will cover innovative business models to deal with digital transformation and sustainability.
This module should provide students with the theoretical knowledge base for better appreciate the other two modules. The module will include theoretical lessons, practical exercises, discussion of real-world case studies, and the testimonials for key player in the industry.
The second module (Module II) deepens on healthcare organizations and the relationship with their external environment. The module addresses the classical management functions demonstrated by the healthcare professional and management concepts essential for understanding the organisational environment. In addition, we will discuss the application of planning and control tools in real-life situations, as well as the importance of relationships within and outside the organisation to improve care delivery.
The third module (Module III) is about discovering the fundamentals practices and challenges of setting an entrepreneurial venture in healthcare, specifically digital health. This module will be delivered by an entrepreneur, and it will include theoretical lessons and practical exercises to develop skills to assess potential threats and opportunities given by new technologies in the healthcare sector.
The teaching method employed in this course drawn inspiration from the old saying “tell me and I will forget, show me and I will remember, involve me and I will understand” (Confucius).
The teaching will be characterized by frontal lessons, case studies, simulations, testimonials and group exercises.
The course may involve presentations by experts, managers and/or business owners for the purpose of better illustrating some of the issues of the course programme.

The assessment of this course will be based on a written exam (100%) relative to the 3 modules reported above. The exam could include a short case study analysis, multiple choice questions and open question/exercises.
In special circumstances, a homework assignment could be considered as an alternative assessement option. Criteria for evaluation will become available at the beginning of the course.
There are no pre-requisites for this class.

Module I
J. Barlow (2016), Managing Innovation in Healthcare, WSP.
Selection of readings and cases uploaded by the lecturer on the Blackboard.
Module II
Selection of readings and cases uploaded by the lecturer on the Blackboard.
Module III
Selection of readings and cases uploaded by the lecturer on the Blackboard.

The recent pandemic teaches us many lessons. One the one side, although some international instruments on infectious diseases exist, there is not enough coordination among states. The international organization in charge of these matters, the WHO, has limited powers and can only intervene to a very limited extent. On the other side, domestic health systems differ, are often based on different premises and standards of protection of population varies, requiring further considerations on the protection of human rights and on the role of health as a public good as a global issue. Moreover, the recent pandemic must be considered within the larger context of climate change, protection of the environment and social rights, since the concept of ‘health’ today has a much broader understanding. These are all matters that require international cooperation and joint efforts. Finally, the current trade system that sustains globalization strongly affects our general understanding of protection of health, and to many extents principles of free trade interfere with those of health protection.
The aim of the course is to start from the recent pandemic to delve into the global governance of health, evidencing the complexity of the issues at stake and proposing a holistic analysis of these. After the course the student:
Will be acquainted with all existing international instruments and organizations focusing on health.
Will be familiar with also WTO, OECD and other international bodies that play an indirect role on cooperation on health and influence the global governance.
Will know human rights approaches on health.
Will have acquired practice with indicators applied by international organizations assessing domestic policies.
Will adopt a holistic approach to health issues at international level.
Will be able to have a critical approach to issues at stake.

The course will address the issues of health and environment protection through the lenses of existing international theory and the most modern approaches on what is usually called “global law”, as a concept going much beyond the analysis of the positive sources of international law (treaties and regulations). Students shall be required to read cases and understand the law in progress, as well as analyse critically concrete examples or actual reports of international organizations. Some economics, political science and theories of governance shall help in better understanding the issues at stake.
To approach global health under all the prospected angles, the course is organized in two interconnected modules. Following an introduction on the works of the WHO and the content of the SDGs in the field of health, these shall develop as follows:
One module, by Professor Villarreal Pascual, will address general issues on human rights norms and standards as well as indicators used to assess their impact on health policies and programs. Additionally, it will delve into an in-depth analysis of the matters above through practical exercises.
Another module, by Prof. Malaguti, will address issues connected to trade and investments, on the one side, and health, food safety and environment protection, on the other side. These will also include treatment of pharmaceuticals, IP and the role of innovation. In this context, also the issue of patentability of viruses will be analysed, as one of the most urgent issues to be considered following the COVID-19 pandemic.
Frontal lessons, case studies and discussions with students. Guests from international organizations and/or ONG may be invited to share their concrete experience with the students.

Students regularly participating into classes will conclude each module by submitting an individual written essay. Final grades will be the average resulting from the combined scores received in the two essays.
Students not participating into classes on a regular basis will sustain an oral exam based on the reference textbook.

Students who follow classes on a regular basis will study on the basis of materials distributed during the course and coming from different sources, in particular actual cases.
Students who do not follow classes on a regular basis shall read the following text, which is in any event a reference textbook for all students who want to have a complete and systematic understanding of the matter and supplement materials received in the course.
Lawrence O. Gostin, Global Health Law (Harvard University Press, 2014)

General Learning Objectives:
To be able to design, operate, and evaluate health care quality management systems and operations.
Knowledge Outcomes:

• Understand why quality management is needed.
• Understand impact of clinical decision making on quality of care.
• Understand impact of administrative systems on quality of care.
• Understand the impact of ancillary processes on the performance of healthcare organizations.
• Understand approaches to measuring quality.
• Understand approaches that have been taken in quality management.
• Understand strengths and weaknesses of different approaches.
• Understand the design and management of health care operations.
• Understand how to design and control a supply chain management system.
• Understand how to create value with healthcare operations management.
  Understand the current trends and innovation in the organization of healthcare productions processes
  Skills Outcomes:
• Ability to apply basic tools of quality improvement such as flowcharting, fishbone diagrams, statistical process control, etc. in health care settings.
• Ability to evaluate reliability and validity of criteria, guidelines, protocols, and other decision making tools.
• Ability to apply information systems for quality measurement and improvement.
• Ability to identify and prioritize opportunities for improvement.
• Ability to determine appropriate methods of improving performance and considerations in implementing such methods.
• Ability to measure the performance of hospital patient flows logistics.
• Ability to design a supply chain management system.
• Ability to implement changes in the organization of healthcare delivery processes.

Health care organizations are required to provide quality health care as a competitive necessity as well as a regulatory requirement and ethical imperative. The course aims firstly to give students a theoretical framework regarding the definition and measurement of quality in healthcare.
Secondly, students will be introduced to the traditional quality improvement techniques such as regulation, credentialing, education, and to new techniques, including continuous quality improvement, system design, clinical pathways, lean thinking, and performance reports.
The course will focus particularly on operations management issues. The use of operations management techniques, extensively applied in businesses of all kinds, has also become a necessity in health care. In order for managers to improve the quality and efficiency of health care delivery, or successfully launch new services or products, they must understand the design and management of health care operations.
Classes consist of both lectures and discussions. Case studies will be used to introduce students to a wide range of practical operational issues in healthcare delivery.
The course is aimed primarily at those students interested in managing health care delivery processes. It will be equally valuable for students interested in careers devoted to the definition of health policies in the public and private sectors.
Finally, a good understanding of operations and supply chain management systems is becoming increasingly important for suppliers (e.g. pharmaceutical and medical devices companies) that aim to develop beneficial and lasting relationships with healthcare delivery organizations.

For attending students, the final grade will be computed as it follows:
Individual assignment (15%)
Group work (15%)
Class Participation (10%)
Mid-term exam (30%)
Final exam (30%)
In the group works students will be involved in a project carried out at the in-campus Gemelli Teaching Hospital. Previus years students have worked, for example, on projects of (i) redesing emergency pathways; (ii) analyis of Operating Room performamce and (iii) optimization of inventories at the central WareHouse.
For non attending students the evaluation will be based on a single written exam on the whole program.

Villa S. (2021) “Operations Management in Healthcare: Theory, Models and Cases” Routledge, London.
Slides, cases studies and readings available on black-board.

The course aims to introduce the student to the world of Big Data. The course will be divided into two parts. In the first part (taught by Prof. Niccolò Salvini) the student will use the R language and its packages, to apply the basic statistical methods learned in a first three-years degree course. The second part (taught by Prof. Giuseppe Arbia) will instead be devoted to introducing statistical models and methods and machine learning approach for the treatment of large and complex amounts of data. The emphasis will be on the practical aspects of implementing the various methods and models and on the interpretation of the results. Computer laboratories using the language R will be held weekly by Prof. Niccolò Salvini.
At the end of the course the student:

• will know how to analyze structured statistical datasets through the use of the R language and the RStudio development environment.
• will know how to distinguish between structured and unstructured datasets;
• will know how to distinguish between supervised models and non-supervised models.

Part 1:
Introduction to Big Data and Data Science. The importance of correct data collection in the world of Big Data. Hypotheses testing on an average and on a percentage. Hypothesis testing on 2 averages and 2 percentages. Hypothesis testing on more than 2 averages (ANOVA) and on more than 2 percentages (CHI square). Multiple linear regression model. Nonlinear regression. Regression with dummy variables.
Part 2:
Factor analysis, Clustering, Discrimination and Classification (Bionomial and multinomial logistic, kernel, general additive regression models, other supervised classification models).
Theoretical lectures and lab sessions on the software R and RStudio ©

Option 1:
Optional intermediate exam on PC after week 6. In the computer lab, students will perform practical exercises using RStudio © software. If successful, the intermediate exam will account for 50% of the final grade. Final examination will be carried out with the same criteria as the intermediate test with a possible additional oral examination. Those who will successfully pass the intermediate exam, at the final exam will be tested only the second part of the course. The intermediate exam can only be used during the winter session at the end of the course, in the January and February appeals.
Option 2:
Full exam in any of the sessions planned during the year. In the computer lab, students will perform practical exercises using R and RStudio © software. Those passing the practical test in the computer lab could be called for an oral examination.

For the logic of the statistical analysis of Big Data it is recommended the following:
Arbia, G. (2021) Statistics, new empiricism and society in the world of Big Data, Springerbrief in statistics, Springer Verlag
The textbook of the course is the following:
James, Witten, Hastie, Tibshirani (2021) An Introduction to Statistical Learning: With Applications in R, Springer-Verlag.

The course aims at introducing the student to a rigorous study of the basic econometric models by studying the statistical properties of the various parameter estimators. It also aims at introducing the student to use of the R © statistical package in an econometric context and to correctly interpreting the results of the estimates.
At the end of the course the student:

• will know the properties of the various estimators and will therefore be able to choose the best in each specific case
• will know how to estimate various types of regression models with the use of the R © statistical software
• will know how to accurately interpret the meaning of the estimated parameters and the different statistical tests calculated to complement the regressions
• will be exposed to the most updated work in health econometrics
• will have notions on how econometric models could be used in the context of public health planning and in evaluating the efficacy of health policies.

Part I (Prof. G. Arbia) (first 40 hours):
Data introduction.
Multivariate linear regression: theory of the Ordinary Least Square (OLS) estimation, Gauss-Markov hypotheses, Maximum likelihood (ML) estimation, Method of moments (MM) estimation. Definition of the marginal effects, dummy and categorical variables as regressors, modus operandi in choosing the best model specification. Violation of the hypotheses of validity of OLS: Analysis of Residuals and Specification Tests (Normality, Endogeneity, Heteroskedasticity, Autocorrelation), Power Transformations, Robust OLS, Instrumental Variable (IV) estimators, Hausman test on endogeneity, Sargan test on exogeneity.
Microeconometrics: Discrete choice models, Limited dependent variable models, and non-linear regression. Definition of the marginal effects and interpretations.
Part II (Prof. F. Moscone) (20 hours):
Applications of regression models in health systems and public health research.
Presentation of the results of scientific articles showing the use of econometric models to support decision making in health planning and health policies evaluation.
Lectures, laboratories with the use of the R © software. On a weekly basis students will be offered laboaratories on the use of R Studio ©. The laboratories sessions will be conducted by Dott. Filippo Ligabue and will be devoted to the application to real health data of different methods.

Option 1:
Optional intermediate exam on PC after week 6. In the computer lab, students will perform practical exercises using RStudio © software. If successful, the intermediate exam will account for 50% of the final grade. Final examination will be carried out with the same criteria as the intermediate test with a possible additional oral examination. Those who will successfully pass the intermediate exam, at the final exam will be tested only the second part of the course. The intermediate exam can only be used during the winter session at the end of the course, in the January and February appeals.
Option 2:
Full exam in any of the sessions planned during the year. In the computer lab, students will perform practical exercises using R and RStudio © software. Those passing the practical test in the computer lab could be called for an oral examination.

Arbia, G. (2024) A Primer for Spatial Econometrics: With Applications in R Stata and Python 2nd edition) Palgrave Texts in Econometrics, Palgrave MacMillan
Baltagi, B. H. and Moscone, F. (eds.) (2018) Health econometrics, Contribution to economic analysis, n. 294, Emerald Group Publishing.
Greene, W. (2019), Econometric analysis, Pearson. Eighth Edition (Global Edition).

The main course objectives are:
1. To provide a way of thinking about health care insurance
2. Understand the different health systems designs
3. A clear analytical way of examining health care reforms and health systems, according to a economic and a public health perspective
4. To understand the policy challenges of insurance, ageing, innovation, and inequality in the health sector.
At the end of the course the student:
Will know the main theoretical models that explain the organizations, governance and management of healthcare systems;
Will be able to define the main domains of functioning in healthcare systems;
Will be able to build a dashboard of indicators to measure the performance of an healthcare systems;
Given a public health issue (eg: vaccination, non communicable diseases,…) will be able to compare the main functions, organization of services (ie, health promotion and prevention, diagnostics, treatment, follow up and rehabilitation), healthcare and non healthcare interventions and policies among a panel of OECD countries.

The course will first outline the approaches to analyze the organization, financing and delivery of health services among different health care models: Focus on analysis of the main health systems in the world.
We will classify and describe the main institutional framework for health policy and the process, content and implementation of this policy.
After classifying the models, we proceed by looking at the main dimensions of the health systems performance and how to compare performance in primary, secondary and tertiary care across the several health models.
Attention will also be paid to specific topics like health insurance, long term care funding, decentralisation, and health inequalities.
The format of this course is a combination of lectures, case discussions, and readings. We will employ the following teaching methods:
(a) Readings from textbooks: To provide basic structure, concepts and techniques.
(b) Readings from journals: To augment the textbooks and provide more rigorous intellectual foundation.
(c) Lectures/Classes/Discussions: To create a coherent framework of studying the source material; to give students a chance to ask questions and clarify their understanding.
(d) Case studies: To apply what has been learnt to real life situations.
Active student participation is essential in the classes. In the classes, the lecturer will introduce the topic/case/experiment/exercise and lead the discussion. Students are encouraged to present pre-assigned material and lead part of the discussion in the class group. Pre-assigned reading of cases and exercises is essential.
Practicals
Evaluation of health care systems; Performance indicators; How to plan services in community settings in several Countries in the world.

The exam is composed of written questions regarding all modules.
There are no intermediate tests.
The evaluation is based on two elements:
1. Group work on the organizations, health needs assessment, governance, allocation and health and non health policies and activities on a public health issue in a given country.
2. Final written test on the second part of the program, through multiple choice items and open ended questions investigating the main course contents.
All the elements of evaluation (group work and final examination) are expressed in 30/30.
All the other details concerning the exam procedures will be given out by each Lecturer at the beginning of the course.

Main readings:
Irene Papanicolas, Dheepa Rajan, Marina Karanikolos, Agnes Soucat, Josep Figueras. Health system performance assessment: a framework for policy analysis. Health Policy Series. World Health Organization 2022. ISBN 978-92-4-004247-6.
de Belvis AG, Meregaglia M, Morsella A, Adduci A, Perilli A, Cascini F, Solipaca A, Fattore G, Ricciardi W, Maresso A, Scarpetti G. Italy: Health system review. Health Systems in Transition, 2022; 24(4): pp.i–203.
Other readings:
Winkelmann J, Scarpetti G, Williams GA, Maier CB. How can skill-mix innovations support the implementation of integrated care for people with chronic conditions and multimorbidity? Copenhagen (Denmark): European Observatory on Health Systems and Policies; 2022.
Budde H, Williams GA, Scarpetti G, Kroezen M, Maier CB. What are patient navigators and how can they improve integration of care? [Internet]. Copenhagen (Denmark): European Observatory on Health Systems and Policies; 2022.
Palm W, Webb E, Hernández-Quevedo C, Scarpetti G, Lessof S, Siciliani L, van Ginneken E. Gaps in coverage and access in the European Union. Health Policy. 2021 Mar;125(3):341-350.

The aim of the course is to acquire language skills needed to interact, understand and produce oral and written Italian in everyday and professional situations. The skills acquired are at level A2+ of the Common European Framework of Reference for Languages (CEFR). Special attention is also given to the presentation of the main aspects of Italian culture, in an international context.
Knowledge and understanding (Dublin 1)
The student should show an ability to identify basic morphosyntactic and lexical alternatives; understand the main ideas of simple texts in Italian, also related their professional field.
Applying knowledge and understanding (Dublin 2)
The student should be able to use a variety of morphosyntactic and lexical structures; respond adequately to comprehension questions, Understand short conversations in everyday life and a professional context.
Making judgements (Dublin 3)
The student should be able to communicate their point of view in a simple way, comparing people, things and situations. They should demonstrate an awareness of the near future and be able to make assumptions.
Communication skills (Dublin 4)
The student should possess an ability to recount past routines, actions begun in the past and still in progress. Can hold short conversations on common or professional topics.
Learning skills (Dublin 5)
The student should therefore be able to understand and give explanations about the Italian language, with reference to language learning strategies.

The course content includes:
study of the discrimination and production of phonemes and rhythmic-intonative structures of the Italian language;
study of morphology and syntax at level A2+ (use of definite and non-definite article; nouns; verb tenses: presente, passato prossimo, futuro semplice of regular/irregular verbs, c’è/ci sono (there is/there are), adjectives; noun-adjective morphological agreement; use of pronouns (simple forms), prepositions and adverbs;
comprehension of oral and written texts about everyday Italian life and the business sector;
oral production and interaction activities in everyday and professional life contexts.
acquisition and expansion of everyday and basic professional vocabulary, with particular reference to the business sector: the company (corporate structure and organizational structure), the language of meetings, applying for a job.
The teaching methodology used, always in accordance with the Dublin descriptors, makes it possible to acquire knowledge and understanding through specific guided and interactive activities, from the presentation of the topics to be studied to the application of the strategies used.
The student will gradually acquire autonomy in the comprehension of oral and written texts up to the A2+ level required by the course, as well as in the production of texts and speeches. Communication skills will be progressively developed and stimulated through specific teaching activities for oral communication in the professional context.

At the end of the course there is an oral exam designed to assess the level of language and communication skills achieved by the student.
The exam includes:
a self-presentation;
a short conversation with the lecturer on topics covered in the Italian language course.
an oral presentation on a topic chosen by the student and addressed in the Degree Programme;
Assessment criteria are as follows:
effectiveness in oral presentation and interaction
grammatical accuracy
lexical mastery
The final mark is out of 30 points. Pass mark: 18/30.

Study materials will be provided through the Blackboard platform.
Recommended reading: Grammatica pratica della lingua italiana by Susanna Nocchi, Alma edizioni.

Pharmaeconomics and Health Technology Assessment (HTA) is a relevant field of studies in health economics, concerned with understanding whether resources are allocated to the most cost-effective treatment or health technology. The aim of this course is to present and discuss selected topics within this field, which are of utmost relevance for the management of healthcare organizations. During the course students will learn both theoretically and empirically how to assess a cost-effectiveness analysis to evaluate the adoption of a new medical treatment or health technology. Theoretical lectures will introduce the basic concepts of pharmaeconomics and HTA, defining how to measure and discount costs and benefits. Then, attention will be paid to the decision-making process, introducing relevant concepts and methods to inform policy makers or hospital managers on whether a new technology should be preferred with respect to the most relevant alternatives. The last part of the course will be devoted to applying the theoretical models thorough intensive lab sessions using the R package BCEA, one of the most popular statistical software to perform Bayesian cost-effectiveness analysis. During lab sessions two case studies will be presented and discussed.
After the course the student:

• will have knowledge about the main aspects of pharmaeconomics and HTA.
• will have knowledge of the main methods to perform cost-effectiveness analysis of new medical treatments/health technologies.
• will be able to apply the knowledge acquired during classes to discuss relevant topics on pharmaeconomics and HTA with an appropriate technical language.
• will be able to apply the knowledge acquired during classes to discuss results of a Bayesian cost-benefit analysis.
• will be able to apply the knowledge acquired during classes to perform independently a Bayesian cost-effectiveness analysis with the R package BCEA.

Part I: Introduction to pharmaeconomics and health technology assessment

• How to measure costs and case study
• How to measure outcomes (effectiveness, monetary benefits, utility)
• Quality Adjusted Life Years (QALYs), methods for extrapolation and case study
• Discounting (both for costs and outcomes)
  Part II: The decision-making process
• Incremental Cost-Effectiveness Ratio (ICER) and the cost-effectiveness plane
• The National Institute for Health and Care Excellence (NICE) and relevant thresholds
• Net Monetary Benefit (NMB) and dominance
• Decision trees
• Markov models
• Introduction to dynamic models
• Bayesian analysis
• Introduction to sensitivity analysis (discrete and PSA)
• How to appraise a paper (checklist)
  Part III: Introduction to Bayesian Analysis and case studies
• Bayesian analysis in health economics
• Basic concepts of health economic evaluation
• Doing Bayesian analysis and health economic evaluation in R
• Case studies: (i) vaccine and (ii) smoking cessation
  Part IV: Using R to perform Bayesian cost-benefit analysis (lab)
• Basic health economics evaluation
• Cost-effectiveness plane
• Expected incremental benefit
• Health economic evaluation for multiple comparators and the efficiency frontier
• Probabilistic Sensitivity Analysis
• Modelling parameter uncertainty
• Value of information analysis
• PSA applied to model assumptions and structural uncertainty
  Classes are organized as frontal and lab sessions. Frontal lectures provide knowledge necessary to understand fundamental concepts of pharmaeconomics and HTA. Lab sessions propose empirical analysis of case studies using models discussed throughout the course.

Evaluation is based on a written exam lasting 60 minutes. The exam is made of three sections. Section 1 comprises 10 multiple choice questions on basic concepts discussed during the course. Each correct answer is worth 1 point; each wrong answer provides -0.5 points. Sections 2 and 3 are open questions and are thought to test the ability of students to apply the knowledge acquired during the course and to communicate using key concepts that they have learned. Instructors will evaluate the completeness and accuracy in answers to mark exams. During the second part of the course students will have the option to prepare a group project that will consist of a replication of an empirical application discussed during lab sessions. Group projects will be discussed and evaluated and will contribute to 30% of the overall evaluation of the second part of the course.

Briggs-Klaxton-Sculpher, Decision modelling for health economic evaluations, Oxford University Press 2011.
Drummond-Torrance-Stoddart, Methods for the Economic Evaluation of Healthcare Programmers, Oxford University Press, 2015.
G. Baio, A. Berardi, A. Heath, Bayesian Cost-Effectiveness Analysis with the R package BCEA, Springer International Publishing, 2017.

The aim of the course is to enable students to develop a specialized knowledge of performance measurement systems in healthcare organizations, including how they can contribute to shape the strategy and assess the level of strategy implementation. A further aim is to enable students to develop the ability to use relevant concepts and terminology in discussing strategy implementation; profit goals, and strategies achievement; techniques of profit planning; balanced scorecard, and transfer pricing.
On completion of the course, students shall be able to:
explain relevant advanced concepts of planning and control in healthcare, associated with models and instruments of performance measurement; demonstrate an integrated view of strategic leadership and controlling processes; classify different types of performance areas and indicators; demonstrate understanding of the meaning of critical thinking and reflection in academic texts and seminars;
use concepts and models of planning, control and performance measurement systems for description, analysis and discussion of the new or unfamiliar managerial issues and practices in healthcare; make proposals concerning planning and control in healthcare, including the performance measurement system with a special focus on managing strategic tensions, and coping with tensions through the diagnostics and interactive control systems;
reflect on financial and organizational control from different perspectives, including an ethical perspective;
critically analyze the consequences of the implementation of different strategies and performance measurement systems’ decisions in speech and in writing;
develop the necessary learning skills for them to continue studying in a largely self-directed or autonomous way or apply for managerial positions.

The course will cover the following contents:
review of the basic concepts of management control;
introduction to performance measurement and control systems in healthcare;
foundations for implementing strategies (organizational tensions to be managed; basics for successful strategy; organizing for performance; using information for performance measurement and control);
Understanding how innovative technologies in health may be integrated for strategic competitiveness
creating a profit plan;
linking performance to internal markets: transfer prices;
building a balanced scorecard;
achieving profit goals and strategies (using diagnostic and interactive control systems; aligning performance goals and incentives; identifying strategic risk; managing strategic risk; levers of control for implementing strategy).
Teaching methods include formal lectures as well as the discussion of case studies and exercises in order to enhance students' active participation and learning. Class participation is strongly recommended.

Grading will be based on a written exam including both essay questions, exercises, and short case studies.

R. Simons, Performance measurement and control system for implementing strategy. Pearson. New International Edition (Chapters: 2, 3, 4, 5, 8, 9, 10, 11, 12, 13, 14) each single module may be purchased at the link: https://hbsp.harvard.edu/strategy execution