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

BACKGROUND: The 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. METHODS: First, 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. RESULTS: Our 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. CONCLUSION: The 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

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

Background The 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. Methods First, 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. Results Our 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. Conclusion The 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

Francia: il percorso nei servizi a Marsiglia

il sistema dei servizi per anziani in Francia, Marsigli

Information use, decision making and public strategies: pushing knowledge forward.

La tesi affronta il tema dell’utilizzo delle informazioni in ambito pubblico sulla scia di quanto avviato dalle teorie di (bounded) rationality, e di diversi filoni di (public) management che si sono occupati nel tempo di indagare i meccanismi attraverso i quali le informazioni vengono identificate, selezionate e utilizzate nei processi decisionali. Attraverso l’analisi delle politiche sociali nei comuni italiani, la tesi si occupa di indagare tre specifiche situazioni: la presentazione delle strategie e politiche pubbliche; la costruzione di piani strategici; la risoluzione di situazioni critiche e di trade-off complessi. La tesi mostra che le informazioni sono usate per presentare le decisioni tramite meccanismi di razionalità ed altri legati alla creazione di consenso per l’innovazione dei contenuti, governance e contesto di riferimento delle politiche sociali. Nella pianificazione strategica le informazioni vengono spesso solamente raccolte oppure utilizzate in modo strumentale. Nel caso di situazioni complesse e caratterizzate da trade-off, le informazioni di accounting hanno sia una valenza manageriale che politica di costruzione del consenso e delle motivazioni ad agire.The PhD thesis deals with the issue of information use in the public sector. Building on (bounded) rationality theories and (public) management studies focusing on mechanisms through which information is identified, gathered and used in decision making processes, the thesis analysed what happens in Italian Municipalities, in the field of social care policies. Three different situations are analysed: public presentation of social care policies; social care strategic plans; wicked problems resolutions and trade off discussion. The thesis shows that information is used to present public strategies through rationality or by building consensus towards innovation in contents, governance and context of social care policies. In the case of strategic plans, information is often only presented or used instrumentally. In the case of trade-offs and wicked situation information is used both in a managerial perspective and in a political fashion so to build consensus and motivation for action

Il settore dell'assistenza sociale e socio-sanitaria alle persone disabili in Lombardia: caratteristiche, criticità, policy

L'articolo, partendo da una analisi empirica sui dati raccolti a livello regionale, propone una analisi del settore sociale e socio-sanitario per i disabili in regione Lombardia evidenziando l'esistenza di un gap di integrazione tra sociale e socio-sanitario riscontrabile nel modello di governance, nei meccanismi di finanziamento e nel sistema di erogazione o produzione dei servizi. In chiusura si propongono alcune innovazioni di policy da adottare per chiudere il gap

I gestori del settore LTC: dati e trend

Approfondimento relativo ai gestori del settore LT

Introduzione: 2020, l’anno delle Residenze Sanitarie Assistenziali?

Introduzione ai contenuti del 3 Rapporto OLTC

La crisi del personale nel settore sociosanitario. Ragioni e possibili vie di uscita

L'articolo approfondisce le principali ragioni della crisi del personale nei servizi sociosanitari per anziani e propone alcune piste di lavoro per affrontarle

Il rapporto tra gli anziani e i servizi esistenti dal punto di vista delle famiglie

Esiti survey tra famiglie rispetto ai bisogni dei caregiver

Il settore Long Term Care per anziani non autosufficienti in Italia: rete di welfare, “badantato”, posizionamento dei gestori e innovazioni in corso

Il capitolo aggiorna la tradizionale fotografia dei dati offerta e di copertura del bisogno della rete di welfare italiana per anziani non autosufficienti