scholarly journals Public, private or hybrid? Providing care services under austerity: the case of Italy

2020 ◽  
Vol 40 (11/12) ◽  
pp. 1279-1300
Author(s):  
Lisa Dorigatti ◽  
Anna Mori ◽  
Stefano Neri

PurposeThe paper examines the different trajectories of externalisation and the development of different kinds of welfare mix in three different sub-sectors of socio-educational services: long-term care for the elderly, early childhood services and kindergartens. By integrating the industrial relations and comparative public administration literatures, it analyses the different rationales underpinning contracting-out decisions of Italian local governments.Design/methodology/approachThe paper adopts a multi-method, multi-level approach: quantitative data on the provision of socio-educational services and the nature of the providers are combined with the analysis of 12 case studies of municipalities through 80 semi-structured interviews and documentary analysis.FindingsThe paper argues that differentials in labour regulation across the public/private divide and the consequent possibility to access labour markets characterised by cheaper labour and higher organisational flexibility are a key explanation in local governments' decisions to outsource. Despite labour market factors playing a prominent role, their relevance is significantly tempered by political and social factors and particularly by the strong opposition of citizens, personnel and trade unions to pure market solutions in the provision of such services. However, the centrality of these factors depends on the nature of the services: political sensibility against privatisation proved to be stronger in kindergartens, while services for the elderly were more frequently and less contentiously privatised.Originality/valueThe main contribution is the integration of the two research traditions to analyse patterns of outsourcing in the socio-educational services in Italy, showing that neither of them is able, alone, to explain the different private/public mix characterising different social and educational services.

2020 ◽  
Vol 40 (9) ◽  
pp. 1397-1419
Author(s):  
Vincent Peters ◽  
Mervi Vähätalo ◽  
Bert Meijboom ◽  
Alice Barendregt ◽  
Levinus Bok ◽  
...  

PurposeThis study examines how modular interfaces manifest in multi-provider contexts and how they can improve coordination and customization of services. The aim of the study is to describe interfaces in multi-provider contexts and elaborate on how they support the delivery of integrated patient care.Design/methodology/approachA qualitative, multiple case study was conducted in two multi-provider contexts in healthcare services: one representing paediatric Down syndrome care in the Netherlands and one representing home care for the elderly in Finland. Data collection involved semi-structured interviews in both contexts.FindingsThis study provides insight into several types of interfaces and their role in multi-provider contexts. Several inter- and intra-organizational situations were identified in which the delivery of integrated patient care was jeopardized. This study describes how interfaces can help to alleviate these situations.Originality/valueThis study deepens the understanding of interfaces in service modularity by describing interfaces in multi-provider contexts. The multi-provider contexts studied inspired to incorporate the inter-organizational aspect into the literature on interfaces in service modularity. This study further develops the typology for interfaces in modular services by adding a third dimension to the typology, that is, the orientation of interfaces.


2020 ◽  
Vol 7 (3) ◽  
pp. 177-185
Author(s):  
Yati Sri Hayati ◽  
Asti Melani Astari

The family has an important role in elderly care at home, where the majority of assistance and long-term care for the elderly is provided by the family. The nurse is responsible for assisting the family in caring for the elderly, so that in the end the family is able to provide elderly care independently at home. This study aims to explore family experiences in caring for the elderly at home. Researchers used qualitative research methods with a phenomenological approach. Data obtained through semi-structured interviews with 6 (six) participants. The research produced 5 themes: care for the elderly is a form of devotion to parents, care for the elderly requires physical and mental readiness, care for the elderly requires knowledge related to the elderly and how to care for the elderly, care for the elderly requires support from extended families, and feel the importance of supporting cadres and health workers. For conclusion, elderly families have a responsibility to meet the needs of the elderly, so that efforts are needed to improve the knowledge and skills of the family in order to properly care for and meet the needs of the elderly.


2019 ◽  
Vol 12 (3) ◽  
pp. 326-337 ◽  
Author(s):  
Caroline Doyle

PurposeThis paper aims to focus on how a public policy designed to address a social problem ultimately became the place brand.Design/methodology/approachThis paper uses a qualitative case study approach focusing on the city of Medellín, Colombia. It draws from fieldwork conducted in Medellín over 2014 and 2015, including semi-structured interviews with an array of local stakeholders.FindingsThe paper concludes that local governments should be aware that the policymaking process can become part of their branding. It also shows the importance of the continual involvement of stakeholders in the place brand process to ensure it is a sustainable brand.Originality/valueThere are limited studies which focus on how a public policy designed to address a social problem ultimately becomes the place brand. This paper shows how a public policy, social urbanism, became the branding of Medellín.


2017 ◽  
Vol 9 (2) ◽  
pp. 145 ◽  
Author(s):  
Katharine Wallis ◽  
Rebecca Tuckey

ABSTRACT INTRODUCTION High-risk prescribing in general practice is common and places patients at increased risk of adverse events. AIM The Safer Prescribing and Care for the Elderly (SPACE) intervention, comprising audit and feedback plus practice mail-out to patients with high-risk prescribing, was designed to promote medicines review and support safer prescribing. This study aims to test the SPACE intervention feasibility in general practice. METHODS This feasibility study involved an Auckland Primary Health Organisation (PHO), a clinical advisory pharmacist, two purposively sampled urban general practices, and seven GPs. The acceptability and utility of the SPACE intervention were assessed by semi- structured interviews involving study participants, including 11 patients with high-risk prescribing. Interviews were audio-recorded, transcribed verbatim and analysed using a general inductive approach to identify emergent themes. RESULTS The pharmacist said the SPACE intervention facilitated communication with GPs, and provided a platform for their clinical advisory role at no extra cost to the PHO. GPs said the feedback session with the pharmacist was educational but added to time pressures. GPs selected 29 patients for the mail-out. Some GPs were concerned the mail-out might upset patients, but patients said they felt cared for. Some patients intended to take the letter to their next appointment and discuss their medicines with their GP; others said there were already many things to discuss and not enough time. Some patients were confused by the medicines information brochure. DISCUSSION The SPACE intervention is feasible in general practice. The medicines information brochure needs simplification. Further research is needed to test the effect of SPACE on high-risk prescribing.


2017 ◽  
Vol 20 (2) ◽  
pp. 286-299 ◽  
Author(s):  
Fátima Ferreira Roquete ◽  
Carolina Campos Ricci Frá Batista ◽  
Rodrigo Caetano Arantes

Abstract Objective: to analyze the care and management demands of Long-Term Care Facilities for the Elderly (LTCFs) in Brazil. Method: an integrative review of literature was carried out, organized into six stages: a) elaboration of a guiding question; b) online search of LILACS, SciELO, PubMed, the CAPES Portal and the Brazilian Society of Geriatrics and Gerontology databases; c) article selection, following the exclusion and inclusion criteria, with the sample composed of 17 articles; d) commented analysis of the selected articles; e) deliberation on the results obtained, formulated from the synthesis and interpretation of the selected studies; f) presentation of the results of the review. Results: the care demands identified are related to the process of caring and assume a working team with geriatric and gerontological knowledge, while the management demands include the means and resources needed so the care can be provided effectively. However, the LTCFs were found to rely on professionals who are unprepared to provide care or to assume an organizational management role, meaning care for the elderly is restricted to the essentials for their basic needs. Conclusion: the care demands were easily identified in the analyzed publications, however, there is a lack of research that evaluates management demands in a broader and more in-depth manner. It is suggested that studies aiming to broaden theoretical knowledge of the care and management demands of LTCFs are carried out, to stimulate effective and positive actions in the practices of these institutions, seeking to offer top quality care to elderly persons that live in these facilities, that responds to the real needs of their current stage of life.


Author(s):  
Yumi Shindo ◽  
Akira Homma

There are two strengths of dementia care services available in Japan. One strength is the creation of the Integrated Community Care System, which aims to provide various services that the elderly might need within their areas of residence. It is the responsibility of local governments to set up the ICCS, because each community has different social resources, as well as differences in the local population and the number of elderly individuals. The other strength lies in the various educational opportunities in dementia available to medical and long-term care professionals. In 2001, the national government introduced educational programmes for care workers in the field of dementia care. In addition, educational programmes for medical doctors, managers of facilities/service centres for people with dementia, medical professionals working in hospitals, pharmacists, and dentists are currently provided under the government’s policies.


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