Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Milan, Italy.
Social and Political Sciences Department, Bocconi University, Milan, Italy.
Health Serv Manage Res. 2020 Nov;33(4):186-199. doi: 10.1177/0951484820928308. Epub 2020 Jun 6.
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.
长期护理是全球福利和医疗保健系统面临的最重要挑战之一。人口和流行病学趋势表明，未来对长期护理的需求将继续增加，而公共系统的投资和应对这一问题的努力还远远不够。一种可能的策略是加强不同护理环境之间的整合，以产生积极的溢出效应。本文以意大利长期护理系统为重点，分析和评估其在区域层面上的表现，包括满足公民长期护理需求和与医院护理整合两个方面。该研究基于国家卫生保健记录和有关长期护理的区域数据，评估实物服务的现状，并通过与护理提供者和政策制定者进行定性焦点小组讨论，对意大利长期护理系统的绩效和弱点进行解释。研究结果表明，由于供应广泛而重要的不足以及无法满足公民的需求，长期护理和医院之间的整合无法发挥作用，长期护理机构投资带来的替代效应也不存在。本文介绍了对这种现象产生原因的不同解释，并向政策制定者和管理者提出了可能需要实施的解决方案。
