Apocalyptic Scenarios and Integrated Policies: Reasons and Problems of a Fund for the Non-Self-Sufficient
A response to the problems of the elderly who are no longer self-sufficient is today the point where we can most immediately assess our capacity to draw up innovative public policies and develop techniques and instruments for integrating the social services and the health service. The institutional, financial, organisational and professional innovations that now appear necessary for running both the health service and the social services need to offer practical solutions to the specific problem of the aging of the population, but also have a high symbolic value in relation to the role of the public sector in solving collective problems and empirically verifying the capacity of both these systems to radically renew themselves.
The Costs of the Failure to Integrate Social and Health Care
That health service costs tend to increase staggeringly is well known. The most recent forecast of PricewaterhouseCoopers Health Research Institute estimates a tripling of its impact on Gdp in the next fifteen years, reaching 21% in the USA and an average of 16% in other OECD countries. Italy’s relatively favourable position at 8.5% will tend to be eroded, if for no other reason than the worldwide tendency of health service consumption, supply systems and costs to converge.
Good Management and Appropriateness of Services
This contribution is intended to answer two questions: 1) what do we mean by cost-performance, efficiency and efficacy; 2) why do we now talk about appropriateness. We can define these terms as follows: * cost-performance means conforming and responding to principles of economics in the sense of parsimony and saving; * efficiency is the situation of maximum productive capacity, at minimum possible costs, in a combination of production or supply of goods and/or services; * efficacy is the capacity to fully produce the desired effect and the obtaining of it. Nothing can be managed, still less managed well, that is, there can be no administration of the goods and/or interests for others, if the principles of cost-performance, efficiency and efficacy are not borne in mind and applied.
The Application of the Principles of Good Management to Health. Role of the Health Units and Centrality of Local Systems
Integration in welfare policies, like the management of the processes of change in our welfare system are often dealt with and analysed from the perspective of the policy maker. In our country this is a response to a deficit in implementing and evaluating public policy and, still more, to the need for a more pragmatic approach to reform in the various areas of state intervention. This perspective becomes indispensable in the health sector, in particular, where the eternal debate on the public-private relation, on the costs of the national health service, or on the inadequacy of our services in relation to continually evolving health needs and demand, almost inevitably lead to large-scale questioning of the reforms carried out, starting from law 833/78, without there being any careful evaluation of the impact and the real effects of these interventions.
Labour Market and Professionalization of the Care and Health System in Italy
This article presents and discusses some characteristic features of welfare work in Italy, to try and understand better some of the challenges that the welfare system is facing today and, still more, will be facing in the near future. To deal with this subject synthetically, I propose to start from two central elements in the development of the Italian labour market in this field. The first, in the social field, is that of the unofficial «carers», that is, the private care work provided mainly by immigrant women to old people who are not self-sufficient and to the disabled. The second, in the health field, is that of the acceleration of the professionalisation process in the last ten years. These two phenomena will involve discussion of the labour market, regulation of the professions and professionalism.
Economic Evaluation in Care and Health Services
Population ageing and technological development in industrialised countries have helped bring to the fore the subject of the efficient allocation of resources in welfare systems. In the health sector, economic evaluation is a tool designed to guide allocation decisions in relation to a crucial dimension of the problem:
the opportunity cost. Since the 1960’s a strong increase in the number of studies has been noted particularly in the pharmacological sector, and in many countries the results of these studies have been used to issue specific guidelines.