Long-term care coverage and its relationship with hospital care: Lessons from Italy on coordination among care-settings

Abstract

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.

Keywords

elderly health policy hospitalisation long term care reform

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References

European Commission. Population ageing in Europe: facts, implications and policies. https://ec.europa.eu/research/social-sciences/pdf/policy_reviews/kina26426enc.pdf (2014, accessed 20 November 2019).

OECD. Preventing ageing unequally. Paris: OECD Publishing, 2017.

Tinker

The social implications of an ageing population. Mech Ageing Dev 2002; 123: 729–735.

OECD. Maintaining prosperity in an ageing society. Paris: OECD Publishing, 1998.

Torrey

Canes: the fiscal implications of an aging population. Am Econ Rev 1982; 72: 309–313.

Gist

Fiscal implications of population aging, in handbook of aging and the social sciences. 7th ed. San Diego, USA: Elsevier Inc, 2011, pp.353–366.

Nazroo

Marmot

Pensions: more information, less ideology: assessing the long-term sustainability of European pension systems: data requirements, analysis and evaluations. Boston, MA: Springer US, 2012, pp.137–152.

OECD. Health policies and data, http://www.oecd.org/els/health-systems/long-term-care.htm (acessed 16 March 2020)

Gori

Long-term care financing: inserting politics and resource allocation in the debate. Int J Health Policy Manag 2020; 9: 77–79.

10.

Costa-Font

Gori

Santana

(2012), Financing long-term care in Southwest Europe: Italy, Portugal and Spain. In: Fonta-Cost J and Courbage C (eds.) Financing long-term care in Europe: institutions, markets and models. Basingstoke, UK: Palgrave MacMillan.

11.

Colombo

Mercier

Help wanted? Fair and sustainable financing of long-term care services. Appl Econ Perspect Policy 2012; 34: 316–332.

12.

Muir

Measuring social protection for long-term care. OECD health working papers, no. 93. Paris: OECD Publishing, 2017. https://doi.org/10.1787/a411500a-en.

13.

de la Maisonneuve

Martins

The future of health and long-term care spending. OECD J Econ Stud 2014: 61–96.

14.

OECD and European Commission. Health at a Glance. Europe: OECD and European Commission, 2018.

15.

Deusdad

Pace

Anttonen

Facing the challenges in the development of long-term care for older people in Europe in the context of an economic crisis. J Soc Service Res 2016; 42: 144–150.

16.

Leichsenring

Billings

Nies

(eds). Long-term care in Europe: improving policy and practice. London, UK: Palgrave Macmillan, 2013.

17.

Johri

Beland

Bergman

International experiments in integrated care for the elderly: a synthesis of the evidence. Int J Geriatr Psychiatry 2003; 18: 222–235.

18.

Wickizer

Wheeler

Feldstein

PJ.

Have hospital inpatient cost containment programs contributed to the growth in outpatient expenditures? Analysis of the substitution effect associated with hospital utilization review. Med Care 1991; 29: 442–451.

19.

Flynn

Smith

Davis

MK.

From physician to consumer: the effectiveness of strategies to manage health care utilization. Med Care Res Rev 2002; 59: 455–481.

20.

Folland

Goodman

Stano

The economics of health and health care ( Vol. 6). NJ: Pearson Prentice Hall, 2007.

21.

Davis

Russell

LB.

The substitution of hospital outpatient care for inpatient care. Rev Econ Stat 1972; 54: 109–120.

22.

Stoller

SP.

Formal services and informal helping: the myth of service substitution. J Appl Gerontol 1989; 8: 37–52.

23.

Tennstedt

Crawford

McKinlay

JB.

Is family care on the decline? A longitudinal investigation of the substitution of formal long-term care services for informal care. Milbank Q 1993; 71: 601–624.

24.

Pezzin

Kemper

Reschovsky

Does publicly provided home care substitute for family care? Experimental evidence with endogenous living arrangements. J Hum Resour 1996; 31: 650–676.

25.

Schweda

Pfaller

Brauer

, et al. (eds). Planning later life: Bioethics and public health in ageing societies. Abingdon/New York: Taylor & Francis, 2017.

26.

Jacobzone

Cambois

Chaplain

, et al. The health of older persons in OECD countries. Paris, France: OECD Publishing, 1999.

27.

Fosti

Furnari

Longo

, et al. CERGAS Bocconi Il sistema sociosanitario e sociale: risposta al bisogno e filiera dei servizi. Rapporto OASI 2018. Milano: Egea, 2016.

28.

Health at a glance 2015. www.oecd-ilibrary.org/docserver/health_glance-2015-77-en.pdf?expires=1572514427&id=id&accname=oid009613&checksum=2B9471B26C83CC02DC614C1A06BB2AE8. (accessed 16 March 2020)

29.

WHO, World Health Statistics. Global Health Observatory database. Geneva, Switzerland: WHO, 2018.

30.

ISTAT. Data on Italian population (Condizioni di salute, fattori di rischio e prevenzione). Roma: ISTAT, 2014.

31.

Berloto

Fosti

Longo

, et al. Rapporto OASI 2019. Milan: EGEA, 2019.

32.

Pettigrew

AM.

Longitudinal field research on change theory & practise.

Organ Sci 1990; 1: 267–292.

33.

Eurostat. Government finance statistics 2018, https://ec.europa.eu/eurostat/statistics-explained/index.php/Government_finance_statistics#Government_debt. (accessed 16 March 2020)

34.

Rotolo

Italia. In: Fosti

Notarnicola

(eds) Il welfare e la long term care in Europa. Milano: Egea, 2014.

35.

Da Roit

Le Bihan

Similar and yet so different: cash-for-care in six European countries’ long-term care policies. Milbank Q. 2010; 88: 286–309.

36.

Longo

Notarnicola

Home care for the elderly in Sweden, Germany and Italy: a case of multi-level governance strategy-making. Soc Policy Admin 2018; 52: 1303–1316.

37.

Arlotti

Aguilar-Hendrickson

The vicious layering of multilevel governance in Southern Europe: the case of elderly care in Italy and Spain. Soc Policy Admin 2018; 52: 646–661.

38.

Perobelli

Notarnicola

Il settore Long Term Care: bisogno, servizi, utenti e risorse tra pubblico e privato. In: Fosti G and Notarnicola E (eds) L’innovazione e il cambiamento nel settore della long term care. Milan: Egea, 2018.

39.

Longo

Notarnicola

Tasselli

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 Serv Res 2015; 15: 152.

40.

Montanelli

Turrini

Evaluating the Reform of Social Services in Italy: a comparative analysis. Int J Publ Admin 2008; 31: 1259–1274.

41.

Lundsgaard

OECD health working papers. Paris: OECD, 2005.

42.

Italian Minister of Health, Statistical Yearbook 2016. www.salute.gov.it/imgs/C_17_pubblicazioni_2859_allegato.pdf (2018, accessed 20 November 2019).

43.

Gori

Rusmini

V rapporto sulla non autosufficienza. Bologna: Maggioli Editore, 2015, pp.57–86.

44.

Wunderlich

Kohler

(eds). Improving the quality of long-term care. Washington: National Academies Press, 2001.

45.

Rodrigues

Huber

Lamura

(eds) Facts and Figures on Healthy Ageing and Long-term Care. Vienna: European Centre for Social Welfare Policy and Research, 2012.

46.

Spasova

Baeten

Coster

, et al. European Social Policy Network (ESPN). Brussels: European Commission, 2018.

47.

Ouslander

Lamb

Perloe

, et al. Potentially avoidable hospitalizations of nursing home residents: frequency, causes, and costs. J Am Geriatr Soc 2010; 58: 627–635.

48.

Research on medical overuse: overdiagnosis and overtreatment in family medicine and primary care. Eur J Gen Pract 2016; 22: 278–286.

49.

Richardson

Supply and demand for medical care: or, is the health care market perverse?

Aust Econ Rev 2001; 34: 336–352.

50.

Jack

Powers

TL.

A review and synthesis of demand management, capacity management and performance in health-care services. Int J Manag Rev 2009; 11: 149–174.

51.

World Health Organization, Integrated care models: an overview, working document. www.euro.who.int/__data/assets/pdf_file/0005/322475/Integrated-care-models-overview.pdf (2016, accessed 20th November 2019).

52.

Berloto

Dalla

PE.

Silver Economy al settore LTC in Italia: dati, sviluppi e tendenze in atto. In: Fosti F and Notarnicola E (eds) Il futuro del settore LTC prospettive dai servizi, dai gestori e dalle policy regionali. Milan: EGEA, 2019.

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