title: Management of vaccinations in Italy: a national survey after healthcare regionalization.
abstract: OBJECTIVE
  The main aim of this study was to describe the effects of regional organization and performance in managing vaccinations, in the light of the institutional devolution recently introduced in Italy.
  
  
  METHODS
  We analysed (1) the general organization of regions for vaccination programmes, (2) the management of four vaccination programmes (combined measles-rubella-parotitis, varicella for children, influenza, and pneumococcal 23-valent for adults). First, we conducted preliminary face-to-face interviews with 16 regional managers of the infective disease prevention departments. Subsequently, we sent them a standardized questionnaire to obtain comparable information on general organization and on the four specific vaccination programmes considered. In all, 14 regions were eventually included.
  
  
  RESULTS
  The survey showed a widespread lack of regional staff involved in the management of vaccinations and a geographical variation in the availability of computerized data collection. We recorded poor coverage for varicella and pneumococcal 23-valent vaccinations compared to MRP and influenza. Prices of the four vaccines varied widely among regions, with only a weak correlation between prices and volumes.
  
  
  CONCLUSIONS
  The major limitation of the survey was the lack of information available at regional level. The piecemeal diffusion of computerized systems and the widespread lack of sufficient staff should mainly explain this. Economic incentives could be offered to regions that achieve national targets. Such incentives should encourage collaboration between central and regional authorities consistent with institutional trends in regional devolution.
authors: CESAV, Centre of Health Economics Mario Negri Institute, Dept of Public Health, Ranica (Bergamo), Italy. lgarattini@marionegri.it
authors: Livio
authors: L
authors: Garattini
authors: Anna
authors: A
authors: Padula
authors: Gianluigi
authors: G
authors: Casadei
mesh_terms: D000328:Adult; D000368:Aged; D019538:Health Care Surveys; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration* / Q000706:statistics & numerical data; D007223:Infant; D007407:Interviews as Topic; D007558:Italy; D008875:Middle Aged; D009313:National Health Programs / Q000458:organization & administration*; D014612:Vaccines / Q000191:economics / Q000600:supply & distribution; D000078329:Workforce; D055815:Young Adult
chemical_list: D014612:Vaccines