title: Health region development from the perspective of system theory - an empirical cross-regional case study.
abstract: Governments are increasingly establishing health regions to deal with current challenges of public health service. These regions are seen as instruments to balance public and private stakeholders, and offer health care to regional citizens as well as to medical/health tourists. However, it is still unclear how the development of such health regions as well as their governance may be conceptualized. We apply Luhmann's system theory approach in the context of a cross-regional case study that compares health region developments in the Autonomous Province of Bolzano-South Tyrol (Italy) with particular regard to the Eastern Dolomites and in the province of Zeeland (the Netherlands). We suggest that Luhmann's system theory provides a useful set of criteria to evaluate and judge health region development. Fully developed health regions can be understood as auto-poietic systems. By emphasizing programs, personnel, and communication channels, these case studies illustrate the suitability of the system theory toolset to analyze the governance and spatial embeddedness of health regions. Additionally, the study contributes to literature by indicating that health regions are closely related to identity issues and to decision making in regions.
authors.affiliation: Institute for Regional Development and Location Management, European Academy of Bozen-Bolzano (EURAC Research), Drususallee 1/VialeDruso 1, 39100 Bozen/Bolzano, Italy. Electronic address: michael.volgger@eurac.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Volgger
authors.affiliation: Center for Health Region Development, Scaldis Academy, HZ University of Applied Sciences, Edisonweg 4, Vlissingen, Netherlands; NHTV Breda University of Applied Sciences, Mgr. Hopmanstraat 1, 4817 JT Breda, Netherlands; CELLO, Universiteit Antwerpen, 2000 Antwerpen, Belgium. Electronic address: Main0003@hz.nl.
authors.forename: Tomas
authors.initials: T
authors.lastname: Mainil
authors.affiliation: Institute for Regional Development and Location Management, European Academy of Bozen-Bolzano (EURAC Research), Drususallee 1/VialeDruso 1, 39100 Bozen/Bolzano, Italy; Chair in Tourism, Catholic University of Eichstätt-Ingolstadt, Pater-Philipp-Jeningen-Platz 2, 85072 Eichstätt, Germany. Electronic address: harald.pechlaner@eurac.edu.
authors.forename: Harald
authors.initials: H
authors.lastname: Pechlaner
authors.affiliation: Academy for Tourism, NHTV Breda University of Applied Sciences, Mgr. Hopmansstraat 1, 4817 JT Breda, Netherlands. Electronic address: ondrejmitas@gmail.com.
authors.forename: Ondrej
authors.initials: O
authors.lastname: Mitas
mesh_terms: D003142:Communication; D003159:Community-Institutional Relations; D003469:Culture; D003657:Decision Making; D015438:Health Behavior; D006291:Health Policy; D006304:Health Status; D006801:Humans; D007558:Italy; D057193:Medical Tourism; D009426:Netherlands; D019982:Organizational Case Studies; D012040:Regional Health Planning / Q000458:organization & administration*; D013598:Systems Theory; D014481:United States; D014492:United States Public Health Service / Q000458:organization & administration
keywords: Cross-border health care; Governance; Health region; Health tourism; Medical tourism; South Tyrol; System theory; Zeeland