title: Intergovernmental relations and Long Term Care reforms: lessons from the Italian case.
abstract: The article aims at analysing the reasons why Italy failed to reform Long Term Care (LTC) policies, focusing on an aspect which has been overlooked: the interplay between LTC policies and the intergovernmental multilevel relationships. In the Italian LTC system, the main central intervention has been the regularisation of migrant care work, while the automatic growth of the cash benefits has accompanied the care needs evolution. Therefore the only institutional change has been a "gradual transformation". The causes of the failure to reform LTC have been mainly related to a strong fragmentation of the policy field, the existence of a universalistic cash benefit, the fiscal constraint. We argue that a further obstacle to reform LTC policies has been the weak and uncertain legislative framework of federalism. The uncertainty on the allocation and distribution of resources and the delay to apply the equalisation mechanism based on needs engendered a lame federalism that contributed to hindering welfare innovations and to increasing the institutional fragmentation. The analysis is partly consistent with previous literature, although it places less emphasis on the role of the constituencies and the scarcity of resources in influencing decisions, focusing more on the implications of the failure to fully realise the federalist reform. This focus shows that to implement institutional change in the welfare system, it is important to take into account the features of the federal governance, the intergovernmental relations, and to address the challenges that are connected to them.
authors: ISSiRFA-CNR (Institute for the Study of Regionalism, Federalism and Self-Government-National Research Council), Rome, Italy. Electronic address: stefania.gabriele@issirfa.cnr.it.
authors: Stefania
authors: S
authors: Gabriele
authors: Swiss Tropical and Public Health Institute, University of Basel, Switzerland; Università Bocconi, Milan, Italy. Electronic address: fabrizio.tediosi@unibas.ch.
authors: Fabrizio
authors: F
authors: Tediosi
mesh_terms: D018166:Health Care Reform / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D006291:Health Policy / Q000331:legislation & jurisprudence; D006801:Humans; D007373:Interinstitutional Relations; D007558:Italy; D008134:Long-Term Care / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D009936:Organizational Innovation
keywords: Federalism; Fiscal blame; Institutional change; Long term care; Social risks