Efficiency, standardization and the complexity of integrating care for old people in a primary care setting in Northen Italy
Francesco Diodati (University of Milano-Bicocca)
Paper short abstract:
This paper explores the relationship between Population Aging and Economic Restructuring in a primary care setting in Northen Italy. It highlights provider's perceptions of standardization and efficiency and the complexity of providing integrated care for old people.
Paper long abstract:
In Italy, the increasing number of complex chronic conditions and the rising demand for long-term care have raised public and institutional concerns about the need to overcome National Health System's fragmentation by developing integrated primary care. However, the implementation of primary care has woven with the economic matter of providing time and cost-effective healthcare services. This paper explores the relationship between Population Aging and Economic Restructuring and its effects on a primary care service to old people in Northen Italy. Drawing on interviews with different health and social professionals on the complexity of providing integrated health and social care for old people, I show the perception of the rhetoric of standardization and efficiency as an image too much mechanical, coherent and objective of health professional's disciplinary boundaries and user's needs. This vision can not acknowledge everyday work of reassembling and mediating fragmented, hid and ambivalent information and thoughts - as well as disciplinary landscapes - in the ongoing tinkering with pharmacological treatments, aids, and home-based care activities. I underline the providers place a high value on the personal and professional experience of cultivating patient-provider-caregiver relationships and negotiating health disciplinary boundaries in practice. And I highlight how all believe health authorities underestimate the effectiveness of time and effort spent due to economic concerns about quantification and standardization of care services. The paper presents extracts from interviews gathered and analyzed by the author in an ethnographic study part of broader multidisciplinary research on primary care services in Northern Italy.
- Discovery, discussion and decision