Can equity be included in a performance evaluation system? Some evidences from the tuscan health care system

Objectives. Can Equity be included in a performance evaluation system? In Italy, the Tuscan Region has tested and now is adopting an integrated model for performance measurement to which the regional administration, the local health authorities, and other stakeholders may refer either in terms of indicators and shared responsibilities. Thoughout this performance evaluation system it is now possible to measure also the capacity to persue equity at a regional and local level. Methods. In 2005 aspects as equity and access to services, that, in a public system, are very relevant and characterize the political strategy, were included in the performance evaluation system to evaluate the action carried out by the local health authorities, i.e. the operative actors of the system. This was achieved identifing equity measures and including them in an essential number of indicators, classified in six dimensions and represented in diagram targets. Results. This comprehensive performance evaluation system helped managers and the regional healthcare system as a whole to learn and to consider equity not only as a political issue but as a management goal. Conclusions. This system, used continuously and systematically at a regional level, is now a public policy tool and supports the Local Health Authorities in keeping equity in their management goals.