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"Handling contradictions in the new Welfare model: the Healthcare study case"


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Social systems "create the conditions" for their own overcoming and development. The Welfare State model is today under challange because the society "internalised" at various levels the goal of extending to increasingly wider population groups, and possibly to all the population, the actual possibility to provide answers the fundamental personal needs. In the field of healthcare, this means that the society reckons to have the potential, the ability and the tools to pursue the health protection goal without having to resort to the direct intervention of the State. However, the 90s reforms implementing such trend show some contradictions, as summarised below:

 

  • Restatement of the "public" purpose of health protection interventions (person's right) but at the same time introduction of private instruments;
  • Reaffirmation of the unitary healthcare system, but at the same time granting of a broad autonomy to the service supplying units;
  • Setting uniform assistance levels, but at the same time granting powers to the Regions contributing to an increasing differentiation;
  • Introduction of competition elements, but at the same time strong emphasis on the principles of coordination and integration of the action of different entities.

 

The Lecture seeks to take stock after 5-6 years of application of Decrees 502/92 and 517/93, in order to verify the extent to which reality adapted to the rules that appeared at the time uncertain in terms of organisation structures, service networks, financing and accountability systems, impact on the changing demand. This "taking stock" will prepare all those who want to play a role in the change to apply the new rules - which inevitably generate other deep contradictions - of the Decrees approved in June by the Government.