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

BMC Health Services Research

Stefano Tasselli¹  Elisabetta Notarnicola¹  Francesco Longo¹ 

[1] CERGAS - Health and Social Care Management Research Center, Public Policy Analysis and Management Department,Bocconi University, Via Roentgen 1, Milan, 20135, Italy

关键词: Health and social care services;    Welfare systems;    Service provision models;    Systems of care;   

Others  :  1171111
DOI  :  10.1186/s12913-015-0800-9

 received in 2014-06-09, accepted in 2015-03-18,  发布年份 2015

【 摘 要 】

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.

【 授权许可】

   
2015 Longo et al.; licensee BIoMed Central.

【 参考文献 】

• [1]Heitzmann K: A new welfare Mix? Theory and evidence for the policy field of poverty relief. Working Paper, ESPAnet Conference, University of Bremen; 2006.
• [2]Chatterjee P, Miller D, Chatterjee MA: Visions of Health Policy: A Comparative Case Study of Seven Modern Countries. Soc Dev Issues 2013, 35(3):18-37.
• [3]Powell M, Barrientos A: An audit of the welfare modelling business. Soc Pol Admin 2011, 2011(45–1):69-84.
• [4]Esping-Andersen G: The Three Worlds of Welfare capitalism. Cambridge University Press, Cambridge; 1990.
• [5]Bouckaert G, Peters BG, Verhoest K: The coordination of public sector organizations: Shifting patterns of public management. Palgrave Macmillan, London; 2010.
• [6]Daly M, Lewis J: The concept of social care and the analysis of contemporary Welfare States. Br J Sociol 2000, 51–2:281-29.
• [7]Jensen C: Worlds of welfare services and transfers. J Eur Soc Pol 2008, 18:151-62.
• [8]Eisenhardt K: Building Theories from Case Study Research. Acad Manag Rev 1989, 14–4:532-50.
• [9]Eisenhardt K, Graebner M: Theory Building from Cases: Opportunities and Challenges. Acad Manag Rev 2007, 50–1:25-32.
• [10]Øverbye E: Disciplinary Perspectives. In The Oxford Handbook Of The Welfare State. Edited by Castles FG, Leibfried S, Lewis J, Obinger H, Pierson C. Oxford University Press, Oxford; 2012:152-66.
• [11]Abrahamson P: The Welfare Modelling Business. Soc Pol Admin 1999, 33–4:394-415.
• [12]Powell M, Hewitt M: Welfare State And Welfare Change. Open University Press, Buckingham; 2002.
• [13]Castles FG: The Future Of The Welfare State. Crisis Myths And Crisis Realities. Oxford University Press, Oxford; 2004.
• [14]Schubert K, Hegelich S, Bazant U: Current State Of Research And Some Theoretical Considerations. In The Handbook Of European Welfare Systems. Edited by Schubert K, Hegelich S, Bazant U. Routledge, London; 2009:3-28.
• [15]Heitzmann K: Poverty Relief In A Mixed Economy. Peter Lang, Frankfurt; 2010.
• [16]Hughes OE: Public management and administration. Palgrave Macmillan, London; 2012.
• [17]Anheier HK: Nonprofit organizations: Theory, management, policy. Routledge, New York; 2014.
• [18]Seeleib-Kaiser M: Welfare State Transformations. Comparative Perspectives. Basingstoke and New York, Palgrave MacMillan; 2011.
• [19]Bode I: Social Care going Market. Institutional And Cultural Change Regarding Services For The Elderly. J Comp Soc Work 2010, 1:1-15.
• [20]Vogel J: The European Welfare Mix. Institutional configuration and distributive outcome in Sweden and the European Union: a longitudinal and comparative perspective. Social Indicators Research 1999, 48:245-97.
• [21]Dahlberg L: Interaction between voluntary and statutory social service provision in Sweden: a matter of Welfare Pluralism, Substitution or Complementarity? Soc Pol Admin 2005, 39–7:710-63.
• [22]Powell M, Barrientos A: Welfare Regimes And The Welfare Mix. Eur J Pol Res 2004, 43:83-105.
• [23]Esping-Andersen G: Social Foundations of Post Industrial Economies. Oxford University Press, Oxford; 1999.
• [24]Barr N: Economics Of The Welfare State. 4th edition. Oxford University Press, Oxford; 2004.
• [25]Ascoli U, Ranci C: Il Welfare Mix in Europa. Roma, Carrocci Editore; 2003.
• [26]Theobald H: Combining Welfare Mix And New Public Management: The Case Of Long Term Care Insurance In Germany. Int J Soc Work 2012, 21:61-74.
• [27]Evers A, Laville J: The third sector in Europe. Northamptom, Cheltenham; 2004.
• [28]Zimmer A: Welfare Pluralism and health care: The case of Germany. In The third sector in Germany. Edited by Zimmer A. Munich University press, Munich; 2000:95-115.
• [29]Borgonovi E: Che cos’è il welfare Mix? In Liberi di scegliere. Dal Welfare State alla Welfare Society. Edited by Vittadini G. Etas, Milan; 2002:170-88.
• [30]Pavolini E: Le nuove politiche sociali. I sistemi di Welfare fra istituzioni e società civile. Bologna, Il Mulino la ricerca; 2003.
• [31]Kasza GJ: The Illusion Of Welfare Regimes. J Soc Policy 2002, 31–2:271-87.
• [32]Goodin R, Rein M: Regimes on pillars: alternative Welfare State logics and dynamics. Publ Admin 2001, 79–4:769-801.
• [33]Bode I: Disorganized welfare Mixes: voluntary agencies and new governance regimes in Western Europe. J Eur Soc Pol 2006, 16:346-59.
• [34]Head BW: Three Lenses of Evidence-Based Policy. Aust J Publ Admin 2008, 67–1:1-11.
• [35]Hansen HF, Rieper O: The Politics of Evidence-based Policy-making: The Case of Denmark. Germany Pol Stud 2010, 6–2:87-112.
• [36]Legge n. 328 dell’ 8 Novembre 2000: Legge quadro per la realizzazione del sistema integrato di interventi e servizi sociali.
• [37]Montanelli R, Turrini A: Evaluating the Reform of Social Services in Italy: a Comparative Analysis. Int J Publ Admin 2008, 31:1259-74.
• [38]Bryman A: Mixed methods research: combining quantitative and qualitative research. In Social research methods. 3rd edition. Edited by Bryman A. Oxford University Press, Oxford; 2008.
• [39]Legge Regionale Regione Emilia Romagna n. 2 del 12 Marzo 2003: Norme per la promozione della cittadinanza sociale e per la realizzazione del sistema integrato di interventi e servizi sociali.
• [40]Legge Regionale Regione Lombardia n.3 del 12 Marzo 2008: Governo della rete e degli interventi e dei servizi alla persona in ambito sociale e sociosanitario.
• [41]Marano A: I tagli all’assistenza in Italia. Motivazioni e conseguenze. Rivista italiana delle politiche sociali 2011, 2:61-88.