The Eclipse of Care and the Italian Job Between Managerial Logic and the Enigma of Health.
A universal healthcare system historically recognised for medical humanism is undergoing systematic defunding through a fiscal threshold of 6.2% of GDP. This analysis examines how New Public Management (NPM) has orchestrated an ontological displacement of clinical practice, transforming medicine fro...
| Publicado en: | Journal of Evaluation in Clinical Practice Vol. 32; no. 4; pp. 1 - 6 |
|---|---|
| Autor principal: | |
| Formato: | review tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Jun2026
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=194811185&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 194811185 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 13561294 EV1 jtl: Journal of Evaluation in Clinical Practice issn: 13561294 maglogo: Y pubinfo: dt: Jun2026 vid: 32 iid: 4 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 194811185 194811185 194811185 10.1111/jep.70469 194811185 ppf: 1 ppct: 5 formats: tig: atl: The Eclipse of Care and the Italian Job Between Managerial Logic and the Enigma of Health. aug: au: Polo, Raul Marco affil: Orthopaedic Department ‐ Clinica Ortopedica, University Hospital Parma – Italy, Parma, Italy sug: subj: Universal Health Care Health Care Reform Health Resource Allocation Ethics, Medical Professional Autonomy Patient Centered Care Italy Narrative Medicine Health Expenditures Waiting Lists Philosophy Sociological Theory ab: A universal healthcare system historically recognised for medical humanism is undergoing systematic defunding through a fiscal threshold of 6.2% of GDP. This analysis examines how New Public Management (NPM) has orchestrated an ontological displacement of clinical practice, transforming medicine from a patient‐centred healing art into a managerially‐controlled process of data extraction and fiscal optimisation. Methods: This paper employs critical philosophical analysis grounded in hermeneutical phenomenology and contemporary social theory, drawing on the work of Martin Heidegger, Hans‐Georg Gadamer, Emmanuel Levinas, Achille Mbembe, and Giorgio Agamben. The analysis interrogates how NPM‐driven austerity in healthcare constitutes a form of ontological violence that simultaneously instrumentalizes patients and strips physicians of clinical autonomy and practical wisdom. Findings: We identify five mechanisms through which managerializaton destroys authentic clinical encounter: (1) ontological reduction of patients to 'standing‐reserve' (Bestand); (2) destruction of meditative thinking in favour of calculative efficiency; (3) elimination of practical wisdo'm (Phronesis); (4) violation of ethical infinity through fiscal totalisation; and (5) creation of necropolitical zones through waiting‐list abandonment. A Constitutional Court judgement has declared that 'irreducible rights must affect the budget, not vice versa'—a principle routinely violated through systematic underfunding. Conclusions: Reclaiming authentic clinical practice requires both material correction (funding floor of 7.5% GDP) and philosophical resistance. Narrative medicine and temporally‐protected clinical encounters represent acts of political resistance against managerial logic. This case study warns that even robust universal systems can be destroyed through bureaucratic defunding masquerading as fiscal responsibility. pubtype: Academic Journal doctype: review tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|