Gli amministratori deleganti nella S.p.A.

La presente tesi intende offrire una ricostruzione sistematica della disciplina applicabile agli amministratori deleganti di S.p.A. post riforma del 2003, attraverso una analisi della disciplina della delega, dei poteri, dei doveri e della responsabilità applicabili a tali amministratori. Il lavoro analizza, in primis, la disciplina della delega di funzioni amministrative ante e post riforma del 2003, evidenziando gli aspetti di continuità e discontinuità tra i due regimi. In secondo luogo, procede a una descrizione analitica dei poteri e dei doveri previsti in capo agli amministratori deleganti post riforma, per determinarne il contenuto e l'estensione. Infine, analizza le responsabilità degli amministratori deleganti per inadempimento dei doveri previsti a loro carico, tentando di dimostrare che la riforma ha attenuato il regime di responsabilità applicabile a tali amministratori attraverso una migliore distinzione del ruolo di tali soggetti rispetto a quello degli amministratori delegati.

Creep and damage models for the service behaviour of structural members

Deformability is often a crucial to the conception of many civil-engineering structural elements. Also, design is all the more burdensome if both long- and short-term deformability has to be considered. In this thesis, long- and short-term deformability has been studied from the material and the structural modelling point of view. Moreover, two materials have been handled: pultruded composites and concrete. A new finite element model for thin-walled beams has been introduced. As a main assumption, cross-sections rigid are considered rigid in their plane; this hypothesis replaces that of the classical beam theory of plane cross-sections in the deformed state. That also allows reducing the total number of degrees of freedom, and therefore making analysis faster compared with twodimensional finite elements. Longitudinal direction warping is left free, allowing describing phenomena such as the shear lag. The new finite-element model has been first applied to concrete thin-walled beams (such as roof high span girders or bridge girders) subject to instantaneous service loadings. Concrete in his cracked state has been considered through a smeared crack model for beams under bending. At a second stage, the FE-model has been extended to the viscoelastic field and applied to pultruded composite beams under sustained loadings. The generalized Maxwell model has been adopted. As far as materials are concerned, long-term creep tests have been carried out on pultruded specimens. Both tension and shear tests have been executed. Some specimen has been strengthened with carbon fibre plies to reduce short- and long- term deformability. Tests have been done in a climate room and specimens kept 2 years under constant load in time. As for concrete, a model for tertiary creep has been proposed. The basic idea is to couple the UMLV linear creep model with a damage model in order to describe nonlinearity. An effective strain tensor, weighting the total and the elasto-damaged strain tensors, controls damage evolution through the damage loading function. Creep strains are related to the effective stresses (defined by damage models) and so associated to the intact material.

Quantifying the Economics of Medical Malpractice - A View from a Civil Law Perspective

Life is full of uncertainties. Legal rules should have a clear intention, motivation and purpose in order to diminish daily uncertainties. However, practice shows that their consequences are complex and hard to predict. For instance, tort law has the general objectives of deterring future negligent behavior and compensating the victims of someone else's negligence. Achieving these goals are particularly difficult in medical malpractice cases. To start with, when patients search for medical care they are typically sick in the first place. In case harm materializes during the treatment, it might be very hard to assess if it was due to substandard medical care or to the patient's poor health conditions. Moreover, the practice of medicine has a positive externality on the society, meaning that the design of legal rules is crucial: for instance, it should not result in physicians avoiding practicing their activity just because they are afraid of being sued even when they acted according to the standard level of care. The empirical literature on medical malpractice has been developing substantially in the past two decades, with the American case being the most studied one. Evidence from civil law tradition countries is more difficult to find. The aim of this thesis is to contribute to the empirical literature on medical malpractice, using two civil law countries as a case-study: Spain and Italy. The goal of this thesis is to investigate, in the first place, some of the consequences of having two separate sub-systems (administrative and civil) coexisting within the same legal system, which is common in civil law tradition countries with a public national health system (such as Spain, France and Portugal). When this holds, different procedures might apply depending on the type of hospital where the injury took place (essentially whether it is a public hospital or a private hospital). Therefore, a patient injured in a public hospital should file a claim in administrative courts while a patient suffering an identical medical accident should file a claim in civil courts. A natural question that the reader might pose is why should both administrative and civil courts decide medical malpractice cases? Moreover, can this specialization of courts influence how judges decide medical malpractice cases? In the past few years, there was a general concern with patient safety, which is currently on the agenda of several national governments. Some initiatives have been taken at the international level, with the aim of preventing harm to patients during treatment and care. A negligently injured patient might present a claim against the health care provider with the aim of being compensated for the economic loss and for pain and suffering. In several European countries, health care is mainly provided by a public national health system, which means that if a patient harmed in a public hospital succeeds in a claim against the hospital, public expenditures increase because the State takes part in the litigation process. This poses a problem in a context of increasing national health expenditures and public debt. In Italy, with the aim of increasing patient safety, some regions implemented a monitoring system on medical malpractice claims. However, if properly implemented, this reform shall also allow for a reduction in medical malpractice insurance costs. This thesis is organized as follows. Chapter 1 provides a review of the empirical literature on medical malpractice, where studies on outcomes and merit of claims, costs and defensive medicine are presented. Chapter 2 presents an empirical analysis of medical malpractice claims arriving to the Spanish Supreme Court. The focus is on reversal rates for civil and administrative decisions. Administrative decisions appealed by the plaintiff have the highest reversal rates. The results show a bias in lower administrative courts, which tend to focus on the State side. We provide a detailed explanation for these results, which can rely on the organization of administrative judges career. Chapter 3 assesses predictors of compensation in medical malpractice cases appealed to the Spanish Supreme Court and investigates the amount of damages attributed to patients. The results show horizontal equity between administrative and civil decisions (controlling for observable case characteristics) and vertical inequity (patients suffering more severe injuries tend to receive higher payouts). In order to execute these analyses, a database of medical malpractice decisions appealed to the Administrative and Civil Chambers of the Spanish Supreme Court from 2006 until 2009 (designated by the Spanish Supreme Court Medical Malpractice Dataset (SSCMMD)) has been created. A description of how the SSCMMD was built and of the Spanish legal system is presented as well. Chapter 4 includes an empirical investigation of the effect of a monitoring system for medical malpractice claims on insurance premiums. In Italy, some regions adopted this policy in different years, while others did not. The study uses data on insurance premiums from Italian public hospitals for the years 2001-2008. This is a significant difference as most of the studies use the insurance company as unit of analysis. Although insurance premiums have risen from 2001 to 2008, the increase was lower for regions adopting a monitoring system for medical claims. Possible implications of this system are also provided. Finally, Chapter 5 discusses the main findings, describes possible future research and concludes.

Determinanti Sociali e Governance della Salute in Zambia: Politiche di Sviluppo ed Empowerment Partecipativo

A 30 anni dalla Dichiarazione di Alma Ata, l'Organizzazione Mondiale della Sanità, sia nei lavori della Commissione sui Determinanti Sociali della Salute che nel corso della sua 62^ Assemblea (2009) ha posto nuovamente la sua attenzione al tema dei determinanti sociali della salute e allo sviluppo di una sanità secondo un approccio "Primary Health Care", in cui la partecipazione ai processi decisionali è uno dei fattori che possono incidere sull'equità in salute tra e nelle nazioni. Dopo una presentazione dei principali elementi e concetti teorici di riferimento della tesi: Determinanti Sociali della Salute, partecipazione ed empowerment partecipativo (Cap. 1 e 2), il lavoro di tesi, a seguito dell'attività di ricerca di campo svolta in Zambia (Lusaka, Kitwe e Ndola) e presso EuropeAid (Bruxelles), si concentra sui processi di sviluppo e riforma del settore sanitario (Cap. 3), sulle politiche di cooperazione internazionale (Cap.4) e sull'azione (spesso sperimentale) della società civile in Zambia, considerando (Cap. 5): le principali criticità e limiti della/alla partecipazione, la presenza di strumenti e strategie specifiche di empowerment partecipativo, le politiche di decentramento e accountability, le buone prassi e proposte emergenti dalla società civile, le linee e i ruoli assunti dai donatori internazionali e dal Governo dello Zambia. Con questa tesi di dottorato si è voluto evidenziare e interpretare sia il dibattito recente rispetto alla partecipazione nel settore sanitario che i diversi e contraddittori gradi di attenzione alla partecipazione delle politiche di sviluppo del settore sanitario e l'emergere delle istanze e pratiche della società civile. Tutto questo incide su spazi e forme di partecipazione alla governance e ai processi decisionali nel settore sanitario, che influenzano a loro volta le politiche e condizioni di equità in salute. La metodologia adottata è stata di tipo qualitativo articolata in osservazione, interviste, analisi bibliografica e documentale.