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The wave preserves that uncertainty rather than converting roles, ownership or agreements into autonomy.", "tags": [], "territory": "Republic of San Marino; Emilia-Romagna cooperation context", "title": "Provider-autonomy and accountability evidence boundary", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://digitallibrary.un.org/record/4002690/files/1367378-en.pdf" }, { "kind": "source_reference", "source": "A roadmap to implementing Health 2020: the experience of San Marino", "url": "https://iris.who.int/server/api/core/bitstreams/b8525c44-a543-4cef-aaea-5ad7ab7bd758/content" }, { "kind": "source_reference", "source": "Renewal of the operational protocol with the Emilia-Romagna Region", "url": "https://www.esteri.sm/pub1/EsteriSM/en/dettaglio_accordi.html?idaccordo=df1f425b-a669-4d7c-bff6-ac38ea76fa0b" }, { "kind": "resolved_document", "source": "single-country score-improvement acquisition", "url": "https://www.esteri.sm/pub1/dam/jcr:6f879d17-c2ea-443e-93b9-8c80a74b37c6/ITA.225.pdf" } ] }, { "analytical_mapping": { "mapping_basis": "2021 national review and 2025 bilateral protocol", "mapping_group": "relationships_and_networks", "mapping_id": "candidate-mapping:SMR:relationships-networks:public-system-ownership-boundary", "source_projection_ids": [ "country-improvement-source:SMR:voluntary-national-review-2021", "country-improvement-source:SMR:emilia-romagna-protocol-2025" ], "support_state": "candidate_supported", "target_slot": "public-system-and-external-partner-boundary", "target_view": "public-private", "typed_fields": { "market_boundary": "The sources do not quantify private provision, ownership shares, spending shares, contract volumes or patient choice.", "reported_provider_structure": "The 2021 review describes ISS as the system's departmental provider organization. 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It does not establish San Marino's private-market structure or ownership and activity shares.", "tags": [], "territory": "Republic of San Marino; Emilia-Romagna external-partner context", "title": "Public-system and external-partner boundary", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://digitallibrary.un.org/record/4002690/files/1367378-en.pdf" }, { "kind": "source_reference", "source": "Renewal of the operational protocol with the Emilia-Romagna Region", "url": "https://www.esteri.sm/pub1/EsteriSM/en/dettaglio_accordi.html?idaccordo=df1f425b-a669-4d7c-bff6-ac38ea76fa0b" }, { "kind": "resolved_document", "source": "single-country score-improvement acquisition", "url": "https://www.esteri.sm/pub1/dam/jcr:6f879d17-c2ea-443e-93b9-8c80a74b37c6/ITA.225.pdf" } ] }, { "analytical_mapping": { "mapping_basis": "2021 national review", "mapping_group": "delivery_and_referrals", "mapping_id": "candidate-mapping:SMR:delivery-referrals:reported-hospital-and-territorial-remit", "source_projection_ids": [ "country-improvement-source:SMR:voluntary-national-review-2021" ], "support_state": "candidate_supported", "target_slot": "iss-hospital-and-territorial-remit-2021", "target_view": "delivery", "typed_fields": { "observed_boundary": "The report's service descriptions do not provide a current facility inventory, patient volumes, wait times, capacity, quality or outcomes.", "reported_delivery_structure": "The VNR describes hospital emergency, outpatient, diagnostic, inpatient, medical and surgical services, and territorial primary-care, promotion and prevention services in the ISS departments." } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Republic of San Marino. 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It records organizational remit, not present delivery capacity or a measure of service performance.", "tags": [], "territory": "Republic of San Marino", "title": "Reported hospital and territorial delivery remit", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://digitallibrary.un.org/record/4002690/files/1367378-en.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "World Health Organization Regional Office for Europe. 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Accordi bilaterali Italia - San Marino. Updated 10 February 2026. https://www.salute.gov.it/new/it/tema/politiche-sanitarie-internazionali/accordi-bilaterali-italia-san-marino/", "country_ids": [ "SMR" ], "coverage_domains": [ "governance", "government_responsibilities", "networks", "referral_design", "reform_history" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": "programmazione sanitaria e socio-sanitaria", "institution": "Italian Ministry of Health", "locator": { "locator_type": "web_section", "section": "Anno 2025 – 18 settembre 2025", "source_word_anchor": "programmazione sanitaria e socio-sanitaria", "source_word_count": 4 }, "material_id": "material:3845eb6563403af8f0e5189b", "notes": [ "Do not convert a cooperation agenda into evidence of operating referrals, shared records, capacity, access, or outcomes." ], "origin": "country-evidence-improvement-sources", "period": "Page updated 10 February 2026; action plan signed 18 September 2025", "publication_date": null, "publication_year": 2026, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "text/html", "response_sha256": "8d3c3a89b6e382855a49ade0bf5183840ff5d09eabc228f3484dfa30365f26ad" }, "statement": "Italy's Ministry of Health records a 2025 action plan with San Marino on health and medical-science cooperation, including health and social-health planning, specialist cooperation and integrated information services. The record does not measure delivery of those areas.", "tags": [], "territory": "Italy and Republic of San Marino", "title": "Accordi bilaterali Italia - San Marino", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.salute.gov.it/new/it/tema/politiche-sanitarie-internazionali/accordi-bilaterali-italia-san-marino/" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "World Bank. World Development Indicators, Hospital beds (per 1,000 people), San Marino, indicator SH.MED.BEDS.ZS. Retrieved 22 August 2026. https://api.worldbank.org/v2/country/SMR/indicator/SH.MED.BEDS.ZS?format=json&per_page=100", "country_ids": [ "SMR" ], "coverage_domains": [ "facility_data", "hospital_organization" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": "Hospital beds (per 1,000 people)", "institution": "World Bank, World Development Indicators", "locator": { "locator_type": "api_resource", "source_word_anchor": "Hospital beds (per 1,000 people)", "source_word_count": 5 }, "material_id": "material:2fd69119d071c4c0d7c36c57", "notes": [ "Keep the 2014 observation year and per-1,000 denominator. Do not turn this national density indicator into facility ownership, bed availability, service activity, referral performance, quality or access evidence." ], "origin": "country-evidence-improvement-sources", "period": "World Development Indicators response retrieved 22 August 2026; latest non-null San Marino observation 2014", "publication_date": null, "publication_year": 2026, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "grey_literature" ], "source_system": null, "source_version": { "detected_media_type": "application/json", "response_sha256": "77053fa0e88e9439609afcad5183c319664182ecc847dad55a19c6d5c7851869" }, "statement": "The retrieved World Bank hospital-bed-density response reports 3.35 beds per 1,000 people for San Marino in 2014, its latest non-null observation. It does not identify facility ownership, bed availability, service activity, patient journeys, referral completion, quality or access.", "tags": [], "territory": "Republic of San Marino, national reporting", "title": "Hospital beds (per 1,000 people), San Marino", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://api.worldbank.org/v2/country/SMR/indicator/SH.MED.BEDS.ZS?format=json&per_page=100" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Pasini P. Making a reality of social and health care integration: lessons from the Italian peninsula. 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It does not provide a national service inventory, a quantitative referral measure, or evidence that integration improved performance.", "tags": [], "territory": "Italian peninsula discussion, including Republic of San Marino", "title": "Making a reality of social and health care integration: lessons from the Italian peninsula", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC3225283/" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Calleja N, Gualtieri A, Terzic N, Scoutellas V, Calleja-Agius J. Managing COVID-19 in four small countries: Initial response to the pandemic in San Marino, Montenegro, Malta and Cyprus. Health Policy. 2022;126(4):281-286. https://pmc.ncbi.nlm.nih.gov/articles/PMC8776625/", "country_ids": [ "SMR" ], "coverage_domains": [ "actors", "authoritative_review", "governance", "hospital_organization", "networks", "reform_history" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": "Initial response to the pandemic", "institution": "Health Policy", "locator": { "locator_type": "article_section", "source_word_anchor": "Initial response to the pandemic", "source_word_count": 5 }, "material_id": "material:b3120111b8524971580b047c", "notes": [ "Do not generalize pandemic-period accounts to current non-emergency operations or national performance." ], "origin": "country-evidence-improvement-sources", "period": "Initial COVID-19 pandemic response through 2021; article published 2022", "publication_date": null, "publication_year": 2022, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "research_literature" ], "source_system": null, "source_version": { "detected_media_type": "text/html", "response_sha256": "3141c9a1e14451d923c0c153e88dcb82d416144dee4143c501100d3283116fcc" }, "statement": "The comparative study discusses the initial COVID-19 response of four small countries, including San Marino, in a pandemic-specific setting. It is not evidence of ordinary-period referral performance, autonomy, or general health-system effectiveness.", "tags": [], "territory": "Comparative study of San Marino, Montenegro, Malta and Cyprus", "title": "Managing COVID-19 in four small countries: Initial response to the pandemic in San Marino, Montenegro, Malta and Cyprus", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC8776625/" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Istituto per la Sicurezza Sociale. Pronto Soccorso. 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