ABSTRACT

Despite its growing care needs, Italy has inertially reproduced its consolidated LTC system, dominated by institutional fragmentation, lack of in-kind services, and resulted in public policies which consist of unconditional cash benefits. This structure has encouraged family-based care arrangements (with gender inequalities) and created a large private care market which is dependent on irregular recruitment of migrant care workers employed by families.

In 2012 an innovative LTC scheme dubbed, ‘Home Care Premium’ (HCP), was introduced as a new experimental programme (limited to public employees and their relatives) addressing the Italian LTC system's problematic features. It provided people in need of care with two benefits using a complex multilevel provision system. This article focuses on the 2014 HCP version, analyses its implementation and reflects critically on the problems undermining the innovation dynamic. In particular, the high degree of local discretion emerging in the programme's implementation and the low take-up among the potential beneficiaries compared to what expected will be considered. These results allow a better understanding of institutional traps and unexpected effects hampering innovation even when the reform is perfectly designed.

摘要

尽管护理需求不断增长，意大利一直在惯性地复制其整合的 LTC 系统，主要是机构分散、缺乏实物服务，并导致公共政策包括无条件现金福利。这种结构鼓励了以家庭为基础的护理安排（存在性别不平等），并创造了一个庞大的私人护理市场，该市场依赖于家庭雇佣的流动护理人员的非正规招聘。

2012 年，一项名为“家庭护理溢价”(HCP) 的创新 LTC 计划被引入作为一项新的实验计划（仅限于公职人员及其亲属），以解决意大利 LTC 系统的问题。它使用复杂的多级供应系统为需要护理的人提供了两个好处。本文重点关注 2014 年 HCP 版本，分析其实施并批判性地反思破坏创新动力的问题。特别是，与预期相比，该计划的实施中出现了高度的地方自由裁量权以及潜在受益者的低接受度。这些结果有助于更好地理解制度陷阱和阻碍创新的意外影响，即使改革设计得很完美。