LIBRI DI GUIDO GIARELLI

Il lavoro è frutto dell’incontro tra la sociologia della salute e la componente più aperta della medicina italiana, che ricerca da tempo nell’incontro con le Medicine Non Convenzionali (MNC) lo stimolo e l’occasione per un suo ripensamento profondo nella direzione di una nuova medicina centrata sulla persona. Ne emerge un quadro variegato dello stato delle MNC, che riflette la tendenza verso un pluralismo sanitario reale, anche se incompiuto e non ancora pienamente legittimato, ricco di forti potenzialità e di tutti gli elementi e le condizioni richieste per un profondo rinnovamento della sanità e della cultura della salute.

After defining the concept of community health governance, the evolutionary differentiation of the Third Sector in the Italian health care system is considered in order to gain a better understanding of both its internal articulation and its external connections with the State, the market and the life worlds. By an analytical grid, three different regional health care systems are then examined to define the actual type of governance implemented and of community partnership built up between the public and the private sectors.

The idea of a ‘Mediterranean paradigm’ characterizing the health systems of Southern Europe is not new: however, this paper furtherly develops this idea by elaborating the concept of ‘macroregion’ in order to compare the four health macroareas of Europe: Northern, Central-Western, Central-Eastern and Southern Europe. Using a connessionistic and multidimensional approach, the peculiar features of the Southern European macro-region are described according to a specific set of variables. Finally, some explanatory hypotheses are examined on the historical background of the health systems of this macro-area in order to grasp also the reasons which make the reform processes quite similar among them and at the same time rather different from those applied in the other European macro-regions.

A significant amount of literature has been published about the health reforms implemented during the last two decades in most post-industrialized countries, but very little analysis has been attempted about the impact on health care systems and medical profession of such reforms. The essay proposes a new model of analysis of the impact of health reforms on the medical profession at three sociological levels: micro, related to the clinical dimension; meso, about the social division of labour; and macro, concerned with the system of structural interactions among the main social actors involved. A synthetic account of the results is given to show how the model was applied in an international comparative research about the changing medical profession in USA and Europe.