Rebba V. (2010).
Il long-term care in Italia: l’attuale mix pubblico-privato e il possibile ruolo delle assicurazioni integrative. Politiche Sanitarie, Vol. 11, N. 2, pp. 113-133.
Italy has been experiencing an increased ageing process and this trend is going to strengthen in the next decades, leading to a strong increase in the demand for long-term care (Ltc). In Italy the supply of Ltc has been traditionally characterised by a low level of public provision and funding, compared with other European countries. Public expenditure on Ltc for the elderly is about 1.18% of GDP: only 52% is for providing home and residential services; the other 48% is represented by cash benefits which can be freely spent by beneficiaries. Most analyses of the Italian Ltc system agree on two points: firstly, the weight of informal and private paid care (provided mainly by low-cost migrant female workers) is more significant than public supply of services; secondly, public cash allowances subsidise only part of the privately paid care (families bear large residual payments). The Italian Ltc system seems completely inadequate to cope with the foreseen evolution of demand, calling for a complete reform. Most of the recent proposals of reform converge on a mixed system structured on two levels: 1) a national scheme of protection for dependent people providing basic levels of Ltc services to be defined explicitely and guaranteed across the country; 2) complementary private insurance schemes (covering Ltc services not, or partially, funded by the basic public scheme) in order both to mitigate out-of- pocket payments and to increase the efficiency in the utilization of private resources. In particular, we analyse the current situation of the Ltc insurance market in Italy and the potential role for complementary insurance within a reformed Ltc system.