Carlo Perucci

Page updated on June 4th, 2009

In charge of the Department of Epidemiology, Asl Rome E

Carlo Perucci, who is responsible for the Department of Epidemiology of Asl Rome E, does not have any doubts concerning the usefulness of outcome indicators or measurement in general. “Only a few health technologies,” he explains, “provide solid scientific evidence of their effectiveness. As for the many others, however, no evidence exists. Therefore, measuring the effect of these interventions and not their effectiveness is not only appropriate but also necessary and compulsory. The aim of measuring the effects of a treatment is to improve it and it also provides useful information in order to understand which factors can modify its effectiveness. However, as well as measuring treatments, a comparison between structures, professionals and population can be made”.

Why is measuring outcomes useful?

More information and communication guarantee greater democracy and equity, above all in public health. As a matter of fact, health systems, whatever type they may be, are a very imperfect market because of an intrinsic characteristic: information asymmetry. A person goes to a doctor or a hospital because he feels unwell. He does not know the reasons why he is sick, but wants his suffering to be relieved. Therefore, he is never a client because he does not know what to buy. He wants to buy less suffering and in many cases he wants to buy survival. For this reason, whatever action aims at increasing a person’s ability to participate in the decisions regarding his health and maybe allowing him to possibly choose who and how he can be treated, improves the effectiveness of health systems and makes competiveness in the quality of treatment more explicit and fairer.

Are citizens able to use the results from the evaluations in the best possible way?

Publishing outcome results is a big step forward in improving the level of democracy. However, undoubtedly it has side effects that need to be regulated. Using language which is too technical in publications can, indeed, produce the opposite results to those intended. That is why I am not too keen on publications: if conditions do not exist to guarantee communication that promotes equity, if existing communication systems are selective and information does not effectively reach everybody, then it is possible that it is not the right time to make them known. That does not mean that data extracted from evaluations cannot continue being a useful tool to promote the improvement of health services. Provided rules exist; and therefore a context in which those data can be used.