LTC reform trends between national and local policies: Insights from Italy
Giovanni Fosti | CeRGAS, Bocconi University
Objective: Long term care is an hot topic around the world. A wind of change and reform is passing through the western countries, since the financial sustainability and the demographic issues are challenging traditional welfare states policies. Main LTC reforms at the national level have touched three traditional pillars (funding, carers and institutional settings) with different levels of success and failure (Gori & Fernandez, 2015). If national government are working hard on these issues, a lot is going on also at the local level, where the attention is more on services and care features then on broad policy issues (Lechevalier et al. 2013). Here, LTC reforms deal more with innovation and transitions in care settings and new ways of involving citizens and users.
Our work offers a picture of what is going on in Italy in terms of LTC innovation and reforms at the local level. We provide an overview of trends in the care sector, reviewing what has been ‘proposed’ as innovative and new, in regional and local policies. We first analyse what happened in the last 2 years in the 20 Italian regions; then we focus on a specific region (Lombardy) to find out what happened at the local level by analysing the strategic plans and policy documents of social care districts for the same periods. Similarities and differences between the regional and the local level emerge, together with a general insight of LTC policy changes in Italy.
Data and methods: Starting from a general assessment of Italian LTC reforms at the national level between 2014 and 2016, we move to the regional level by analysing regional reports and policy documents: we perform a desk content analysis looking through regional official documents related to LTC policies to map every possible sign of reform. In this work we use the word ‘reform’ to point out every new policy trend or change compared to previous policies features (i.e. different funding system, new services, different access criteria, …). For what concern the local level, we benefit from the strategic process that involved the 98 social care districts of the Lombardy region in 2015, when they were enrolled in a three years planning initiative. We analyse the strategic and policy documents they produced, in order to map innovations and changes they proposed when defining future local LTC policies.
Results: Our analysis show that when speaking about ‘changes and reforms’ the national, regional (or intermediate) and local level point out different issues and proposal. Moving from the national to the local level, they shift from a pressure on funding to the importance of innovation and quality of services. The Italian insights we provide is also useful to map innovative ideas and services for the elderly.
Policy implications: Our work is useful both for Italian and European policy makers, since it provides a general picture of trends and future challenges for the LTC sector.
 Gori, C., & Fernandez, J. L. (2015). Long-term Care Reforms in OECD Countries. Policy Press.
 Lechevalier, A., Giraud, O., & Kumpers, B. (2013). Policy learning and innovation in local regimes of home-based care for the elderly: Germany, Scotland and Switzerland (No. halshs-00788968).