Lost in translation. Institutional traps and unexpected effects hampering innovation in Italian LTC policies

Abstract

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.