Abstract

An institutional framework can be defined as the set of formal rules that envisage how an organization should work. In the public sector, instead of reflecting managerial and organizational needs, these rules tend to reflect a variety of concerns typical of a democratic society, such as guaranteeing citizen representation, and maintaining balance of powers and political equilibrium. By taking a managerial perspective, the paper discusses the impact of the Italian NHS institutional design on public healthcare organizations. The paper focuses on the following two issues: a) the relationships between the Regions and the central government in the management of the NHS; b) the definition of healthcare organizations' territorial boundaries. The conclusions suggest that managerial requirements deserve greater consideration when reforming the institutional framework of the healthcare system in Italy.