Evaluating the Reform of Social Services in Italy: A Comparative Analysis

Long-term care for the elderly is one among the most important challenges for welfare and health care system across the world. Demographic and epidemiological trends are signalling that demand for long-term care will continue increasing in the next future, while public systems investments and efforts to cope with this issue are not enough. One possible strategy could be to reinforce integration between different care settings so to have positive spill over effects. The paper is focussed on Italian long-term care system analysing and assessing its performance at the regional level both in terms of answering citizens’ long-term care needs and integrating with hospital care. The study is based on National health care records and regional data concerning long-term care to assess the state of the arts of in-kind services, and on qualitative focus groups with care providers and policy makers to provide interpretation about the Italian long-term care system performance and weaknesses. Results show that, due to a widespread and important lack of supply and inability to answer to citizens’ needs, integration between long-term care and hospitals is not working, and substitution effect following investment in long-term care settings is not present. The paper introduces different interpretations of the causes of this phenomenon, suggesting to policy makers and managers the possible solutions to be implemented.

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A framework to assess welfare mix and service provision models in health care and social welfare: case studies of two prominent Italian regions

Longo

Notarnicola

Tasselli

2015

BMC Health Serv Res

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BackgroundThe mechanisms through which the relationships among public institutions, private providers and families affect care and service provision systems are puzzling. How can we understand the mechanisms in these contexts? Which elements should we explore to capture the complexity of care provision? The aim of our study is to provide a framework that can help read and reframe these puzzling care provision mechanisms in a welfare mix context.MethodsFirst, we develop a theoretical framework for understanding how service provision occurs in care systems that are characterised by a variety of relationships between multiple actors, using an evidence-based approach that looks at both public and private expenditures and the number of users relative to the level of needs coverage and compared with declared values and political rhetoric. Second, we test this framework in two case studies built on data from two prominent Italian regions, Lombardy and Emilia-Romagna. We argue that service provision models depend on the interplay among six conceptual elements: policy values, governance rules, resources, nature of the providers, service standards and eligibility criteria.ResultsOur empirical study shows that beneath the relevant differences in values and political rhetoric between the case studies of the two Italian regions, there is a surprising isomorphism in service standards and the levels of covering the population’s needs.ConclusionThe suggested framework appears to be effective and feasible; it fosters interdisciplinary approaches and supports policy-making discussions. This study may contribute to deepening knowledge about public care service provision and institutional arrangements, which can be used to promote more effective reforms and may advance future research. Although the framework was tested on the Italian welfare system, it can be used to assess many different systems.

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Evaluating the Reform of Social Services in Italy: A Comparative Analysis

Cited by 4 publications

References 8 publications

Italian Utilities and Public Control: Evidence of Merger Effects

Italian Utilities and Public Control: Evidence of Merger Effects

Long-term care coverage and its relationship with hospital care: Lessons from Italy on coordination among care-settings

A framework to assess welfare mix and service provision models in health care and social welfare: case studies of two prominent Italian regions

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