CeRGAS Centro di Ricerche sulla Gestione dell Assistenza Sanitaria e Sociale
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1 CeRGAS Centro di Ricerche sulla Gestione dell Assistenza Sanitaria e Sociale Giovanni Fosti,Ornella Larenza, Francesco Longo, Elisabetta Notarnicola, Andrea Rotolo, Stefano Tasselli
2 CeRGAS Bocconi - 2 Agenda inspiration Benefits Long term The Italian Welfare System: inspiration Benefits Long term providers
3 CeRGAS Bocconi - 3 inspiration Benefits Long term Source: Istat
4 CeRGAS Bocconi - 4 Organization inspiration Benefits Long term Central Level Regional Level Local Level Source: Cergaselaboration on ISTAT 2011 (Italy); Inhabitants It has legislative powers on subjects established by the Constitution Medium size: inhabitants They have general legislative power statutory autonomy Medium size: inhabitants Intermediate between Regions Municipalities Medium size: inhabitants They represent the local communities, they defend their interests they encourage their development
5 inspiration CeRGAS Bocconi - 5 inspiration Benefits Long term From isolate specific s interventions From Centralization () From Fragmented Pension Insurance Funds Sources: Ferrera, Fargion, Jessoula (2012), Alle radici del welfare all Italiana To a Public Welfare System (even if with a certain degree of fragmentation) To a decentralized Welfare (Local Level) To National Pension Insurance Funds
6 CeRGAS Bocconi - 6 Welfare pillars inspiration Benefits HEALTH LTC AND INVALIDITY Integrated health social The Italian Welfare System is based on three main pillars it is considered to be a conservative-coroporativist. 1.HEALTH CARE: through the National Health Care System all inhabitants have health coverage 2.SOCIAL CARE: it provides services to different categories of people 3.PENSIONS PENSIONS: remuneration for retirees insurance for specific risks Long term PENSIONS LABOUR, UNEMPLOYMENT LTC AND INVALIDITY FAMILY AND CHILDREN SOCIAL EXCLUSION LTC AND INVALIDITY HOUSING Sources: Il Welfare in Europa, elementi per un confronto Fondazione Zancan, (Oleari, Patacchia, Spizzichino)
7 CeRGAS Bocconi - 7 INTERVENTION AREAS: PENSIONS HEALTH interventions LABOUR, UNEMPLOYMENT, ACCIDENT AT WORK HOUSING policies FAMILY AND CHILDREN interventions SOCIAL EXCLUSION POVERTY policies LONG TERM CARE INVALIDITY interventions inspiration OLD AGE PENSIONS AND SURVIVORS UNEMPLOYMENT INSURANCE FUND LONG TERM CARE INSURANCE SSN CASH ALLOWANCES AND INKIND SERVICES MANAGED AT THE LOCAL LEVEL BY MUNICIPALITIES WORK ACCIDENTS INSURANCE FUNDS Benefits PENSIONS AND SOCIAL SECURITY HEALTH CARE SOCIAL WELFARE Long term CASH BENEFITS CASH BENEFITS AND SERVICES INKIND SERVICES INKIND NATIONAL INTERVENTIONS LOCAL INTERVENTIONS
8 CeRGAS Bocconi - 8 Welfare resources inspiration Total per capita Welfare : target groups interventions (, ) : MACROPERIMETER Mln MESOPERIMETER Mln PER CAPITA Benefits Long term MICROPERIMETER Mln Source:CergasElaboration on BilanciosocialeINPS 2010, Istat 2009, Ministerodel Lavoroe Politichesociali 2009, BilancioINAIL 2010, Rapporto Coesione Sociale Istat 2010
9 CeRGAS Bocconi - 9 Welfare resources WHICH INSTITUTION HAS THE CHARGE OF ALLOCATING THE FUNDING? In the chart we show the distribution of the total Welfare between different actors. inspiration Benefits CENTRAL LEVEL: INPS, INAIL, INPDAP Long term Source: Cergas Elaboration on Bilancio sociale INPS 2010, Istat 2009, Ministero del Lavoro e Politiche sociali 2009, Bilancio INAIL 2010, Rapporto Coesione Sociale Istat 2010
10 CeRGAS Bocconi - 10 CONTRIBUTIONS FOR PENSIONS inspiration CONTRIBUTIONS FOR SICKNESS AND MATERNITY LEAVES CONTRIBUTIONS FOR UNEMPLOYEMENT CONTRIBUTIONS FOR WORK RELATED INJURIES INPS INAIL PENSIONS AND SOCIAL SECURITY BENEFITS Benefits Long term CITIZENS FIRMS TAXES TAXES CENTRAL LEVEL REGIONAL LEVEL AND LOCAL HEALTH AUTHORI- TIES LOCAL LEVEL HEALTH CARE SOCIAL WELFARE BENEFITS AND SERVICES
11 : benefits CeRGAS Bocconi - 11 LONG TERM CARE inspiration DISABLED Benefits Long term CASH BENEFITS INKIND BENEFITS Indennità di accompagnamento Assegni di cura Cash benefits for informal giving Home services (ADI SAD) Residential services Semi-residential services Support services for informal giving Cash benefits for disabled persons Home services Residential services Semi-residential services
12 : governance CeRGAS Bocconi - 12 inspiration Benefits Long term Central Gov. INPS Municipalities Private providers Regional Government Local Health Authorities
13 CeRGAS Bocconi - 13 : Long term inspiration Benefits Long term In the chart we show the composition of the overall for Long term (dependent elderly disability) focusing on different actors that finances the. We also underline if the is financed from the central level of governement or from the local level. We add an estimation of the private out of pocket. LONG TERM CARE EXPENDITURE TOTAL, Millions of PER CAPITA on the overall Population, Local Authority Health Social security (invalidity benefits, Long term Insurance programs, invalidity disability allowances) Total public Of which at the central level Of which at the local level Estimated out-of-pocket Total public + out-of-pocket Source: Cergas Elaboration on Bilancio sociale INPS 2010, Istat 2009, Ministero del Lavoro e Politiche sociali 2009, Bilancio INAIL 2010, Rapporto Coesione Sociale Istat 2010
14 inspiration Benefits Long term CeRGAS Bocconi - 14 : Long term ELDERLY Beneficiaries of residential services (2009) Total numberof elderlypeople in residential services ADI (Home service provided by Local Health Authorities) (2011) Number of ADI Number of Indennità di accompagnamento (cash benefit provided by INPS) (2011) Total numberof Indennitàdi accompagnamento Total N Beneficiaries per over ,6 Beneficiaries of semi-residential services(2009) Total numberof elderlypeople in semi-residential services DISABLED Disabled persons in residential services(2009) Total numberof disabledpersonsin residential services N Beneficiaries per inhabitants 20,7 Disabled persons in semi-residential services(2009) Total numberof disabledpersonsin semi-residential services Source: Ministero della Salute 2012 N ADI Indennità di accompagnamento are only two types of possible home services cash benefits for elderly
15 : benefit mix CeRGAS Bocconi - 15 inspiration Benefits Long term
16 : services providers CeRGAS Bocconi - 16 inspiration Benefits Long term Precise data about the overall number the nature of services providers for long term in Italy are not available. In general, providers tend to specialize in a single area of intervention in a single part of the providing process (e.g. home vs residential) The average size of providers is very small compared to health s health services providers In Italy, there are about informal givers ( are immigrants). This means that there is one informal giver each 15 persons over 65 (estimates by IRS, 2006) The economic value of informal giving provided by familiars is 4,84 billion euros, according to estemates made by Fondazione Censis About 2,457 billion euros is the private out-of-pocket for long term esteemed by Fondazione Censis (data from 2005) Source: S. Pasquinellie G. Rusmini, 2008, Badanti, la nuova generazione, IRS, Fondazione Censis Long TermCare e Assistenza Integrativa Public private providers Informal Out of pocket
17 : need coverage CeRGAS Bocconi - 17 inspiration 65 + OVERALL POPULATION IN NEED OF LONG TERM CARE 65 + population PREVALENCE RATE 18,50% ESTIMATED NUMBER OF 65 + DEPENDENT OVERALL POPULATION (A) ESTIMATED NUMBER OF 65 + DEPENDENT OVERALL POPULATION WITH PREVALENCE RATE = 18.5% (B) Benefits Long term 65+ POPULATION INCLUDED IN LONG TERM CARE (C) % OF 65 + POPULATION IN NEED OF LONG TERM CARE INCLUDED IN WELFARE (C/B) 95,14% % OF 65 + POPULATION IN NEED OF LONG TERM CARE INCLUDED IN WELFARE NATIONAL PREVALENCE (A/C) 95,14% SOURCES: Cergas elaboration on ISTAT , ISTAT - Sebastiani, Iannucci. Vannoni, Disabilità e non autosufficienza - pubblicato su Monitor, 3 supplemento al n. 22
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