A framework to assess welfare mix and service provision models in health care and social welfare: case studies of two prominent Italian regions

Background: The mechanisms through which the relationships between public institutions, private providers, and families affect systems of care and service provision are puzzling. How can we understand the mechanisms in these contexts? Which elements should we explore to capture the complexity of care provisions? The aim of our study is to provide a framework that can help read and reframe these puzzling mechanisms of provision care provision in a welfare mix context. Methods: Firstly, we develop a theoretical framework for understanding how service provision occurs in care systems characterized by a variety of relationships between multiple actors, using an evidence based approach looking both at public and private expenditures and number of users related to the level of needs coverage, compared to declared values and political rhetoric. Secondly we test this framework in two case studies built on data from two prominent Italian regions, Lombardy and Emilia-Romagna. We argue that models of service provision depend on the interplay between six conceptual elements, including policy values, governance rules, resources, nature of the providers, service standards and eligibility criteria. Results: Our empirical study shows that, beneath relevant differences in values and political rhetoric between the case studies in two Italian regions, there is a surprising isomorphism in service standards and the level of coverage of the population’s needs. Conclusion: The suggested framework appears to be effective and feasible, it fosters interdisciplinary approaches, and supports policy-making discussions. This study may contribute to build a deeper knowledge about provision of public care services and institutional arrangements, which can be used to promote more effective reforms and may advance future research. Even if the framework is tested on the Italian welfare system, it may be used to assess many other different systems.