RICERCA ITALIANA     

New Health Needs and Care Services: Governance, Organisations, Professions and Citizens in the Integration of Health and Social Care

Università degli Studi di Macerata

Abstract

Background:
The need to provide social and health services in an integrated manner (IHSC) is increasingly recognized in Western Europe, mainly as a result of two processes developing in the last thirty years: on the one hand there is an increase of people with chronic diseases, who often require more extensive than intensive care; on the other hand, health and social policies seek to move increasingly towards a de-institutionalization and de-hospitalization of interventions in order to maintain people in their community and home environments and also to contain costs. As this awareness grows, the practical translation of these principles faces difficulties in good part due to the fact that the social and health sectors are largely produced by different institutional, organizational and professional system and often competing with each other. The general objective of IHSC is to obtain unitary answers to health needs in order to enable citizens to reach the highest level of autonomy, personal expression, quality of life, involvement in social life. Robert K. Merton back in the'50s focused the attention on the concept of "patient as a total person", being the crucial issue of IHSC not the merging togheter two sectors (the social and health ones), but the making them to interact for a plan with at the center the person in her/his psycho-physical unity. The interconnection between social services and health services should take place at three levels >>>

Principal Investigator

Emmanuele Pavolini Università degli Studi di MACERATA

Research Objectives

Final Objectives:

This project has three main goals. Each of these three main goals has more specific research questions. These goals have both a theoretical and applied nature in the field of IHSC. Finding answers to theoretical questions means to propose models of intervention more careful to the needs of IHSC and users. In particular we will analyze how the relationships among different actors involved at different levels in the process of IHSC are growing and transforming: public actors belonging to different institutions (Municipalities, Health, educational system, etc. .); private ones (those that run services, non-profit associations); the families of users and beneficiaries; the various types of professionals working in the field.
The three main goals of this project can be put into a framework of macro-meso-micro analysis:
- Macro - characteristics of governance models: given the economic importance and the centrality of health and social-sanitary services in local contexts, the social-sanitary integration is an ideal issue to analyze changes in various Italians contexts, with reference to relations between different public actors (in this case Regions, hospitals, local health companies and municipalities), private actors with roles in management services (for profit and nonprofit), associations for the protection of users and labor union, as the relationship between politics, bureaucracy and civil society; the importance of this >>>

First Results

Altogether the predicted results of the project are twofold: theoretical and applied. In particular taking into consideration the three general goals of the research, the main expected theoretical results are:
1. Macro goal - characteristics of the models of governance:
• Individuation of the mechanisms and processes that explain the success of collective action among a variety of actors, private and public, in the attempt to create models of IHSC in one logic of governance; in particular it is expected to understand how much some of the more recurrent explanations in the social studies with respect to the dilemmas of collective action are satisfactory in order to interpret the analyzed phenomenon and, above all, if these explanations can be integrated with each other (political economy, network theory, approaches more oriented toward methodological individualism, with the focus on the role of the actors and their entrepreneurial abilities); following attempts that are increasingly being diffused in the social analysis it is expected to find proofs/hints on one side of the explicative ability of several models of interpretation, on the other of the possibility of a combined use of some of these different models (e.g. Mizruchi, 2007, is among those scholars who try to conjugate the political economy approach with network analysis).
• Forms taken by the horizontal subsidiarity and the interaction between community and institutions in the field of IHSC; in >>>

Timescale

24 months

National and international background

The studies that in Italy and at the international level focus on different dimensions of the integration process of health and social services (institutional, organisational and professional) are relatively spread, but they often display one of the following two features.
On one hand, many of them are investigations based on a descriptive- prescriptive more than interpretative view. They aim to give a framework of the current situation of IHSC or to provide suggestions and advices for improving it. Moreover, the analyses based on a sociological perspective tend to study the integration process looking more at the Social Care actors (the municipality’s view); while the managerial / medical studies analyse it by the health care system perspective. Indeed, it is difficult to fine analyses integrating both social and health care dimensions.
Beside the individual contributions, there are reviews which sometimes publish articles on this topic by a sociological and political perspective or by a multidisciplinary one. Hence, there is lack in this literature of a wider theoretical interpretation on the current process. It makes often the proposed solutions too much technical and specific and not rooted / ‘embedded’ in the social-cultural-political context where they should take place. Quite a good part of the international comparative researches on the issue tend also to use the just illustrated above approach: these researches study and show the mechanisms of IHSC >>>