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A tale of integration and fragmentation: LTC services provision in four European cities

2014 Conference Presentation

(Inter)national systems Italy

1 September 2014

A tale of integration and fragmentation: LTC services provision in four European cities

Giovanni Fosti, Bocconi University, Milan, Italy
Francesco Longo, Bocconi University, Milan, Italy
Elisabetta Notarnicola, Bocconi University, Milan, Italy
Andrea Rotolo, Bocconi University, Milan, Italy
Stefano Tasselli, Bocconi University, Milan, Italy


Moving from general settings of Long Term Care systems in four European countries – France, Germany, Italy and UK – we investigate the micro-level of services delivery process. We adopt a managerial perspective, considering both users and suppliers’ points of view, to compare different stages of services provision process. The objective is to empirically assess users experience in care provision in the four countries, by comparing their pathways, from the emergence of the need for care to its satisfaction, providing some evidences to help national policy makers to improve LTC for the elderly in their countries.

Data and Method: Since we are interested in LTC provision process, and more specifically in the provision of public funded LTC interventions, we have studied what happen at the local level (micro-level) by analysing four European countries: Parma (Italy), Oxford (Uk), Marseille (France), Leipzig (Germany). We tried to retrace the real pathway that an elderly, or his family for him, has to go through to have access to the LTC system, trying to have a well-rounded vision on all the services he may need (in kind services or cash benefits) rather than on a single intervention. We have thus developed four in-depth case studies, based on data collection with a preliminary desk analysis, and 23 on-site interviews with key well-informed key actors in the LTC. The interviews were focused on elderly experience during the services provision process. Following previous literature (Hardy et al., 1999; Katsaliaki et al., 2005; Katz et al., 2013) we have identified four different stages -- First contact and Information; Need assessment; Benefits and service design; Service delivery – and we have tried to trace what happen to the elderly in every single stage to catch different care models and managerial approaches.

Results: The four case studies allowed us to sketch pathways of LTC for the elderly in four European countries, describing what happen from the emergence of the need to the provision of 26 different LTC services, resulting in an insightful description of LTC systems from the users’ point of view. Our analysis shows that different care models have been adopted, determining completely different experiences for the elderly and their families. It also shows that institutional design, regulation and service features make the difference in terms of integration or fragmentation of LTC provision.

Policy Implications: The research can be used by policy makers both on a national and on a comparative perspective. From the national perspective, policy makers can learn how policy design in their country impacts in real terms on users’ experience. From a comparative perspective, they can learn which model better responds to users’ needs and reach integration.