Multi‐level governance and central‐local tensions: The issue of local discretion in long‐term care policy in Italy

Abstract

Welfare reforms introduced at national level and implying changes in service provision are often managed by local authorities, and this fact paves the way for strong local‐central tensions. One of the sources of such tensions is the spread of local discretion in the implementation of central programs. In current literature, local discretion has been considered as a way not only to preserve local autonomy but also to capture central resources or to shift cost burdens upwards. This opportunistic behaviour is especially spread in countries characterized by weak vertical coordination in their multi‐level governance system. This paper investigates the dynamics of local discretion as a specific phenomenon relating to central‐local tensions by observing the implementation of an innovative national long‐term care program (Home Care Premium), in a national context (Italy) characterized by a high degree of institutional fragmentation. The findings show that, in spite of the programme's centralistic orientation and generous funding, specific discretionary practices have been extensively adopted by local authorities to develop strategies aimed at shifting the costs of local service provision towards central funding. Using a specific measure of local discretion, we examine first the territorial distribution of discretion over the country. Then, a regression model is developed to explain to what extent local discretion is explained by demand‐side, supply‐side or policy legacy factors. Results show the relevance of territorial socio‐economic inequalities in explaining local discretion and related cost‐shifting behaviours by local authorities located in poorest, highly deprived areas.

Participation in welfare legislation—A poverty‐aware paradigm

“…In doing so, they recommend and support rules that are out of touch with the lived experience of those dealing with the hardship of poverty. In contrast, when bureaucrats do truly "see" people in poverty, they are in a position to remedy at least some of the problems and injustices discussed here (Arlotti et al, 2020;Keiser, 1999;Lipsky, 1980). My insistence on the rulemaking lens is based on the premise that there is an intrinsic value in rules being good rules, even if we have some ways to mitigate the effect of bad ones.…”

“…Against this backdrop, it is important to acknowledge that, while this paper criticizes the process of rulemaking in the welfare law field, its purpose is not to call for the elimination of rules and the abolition of general laws, since it is in this field specifically that the open‐discretion system's downfalls are all too visible (discretion, of course, having its important strengths). For a full discussion on this point, see, for example, Arlotti et al (2020), Brodkin (2020), Handler (1983), Keiser (1999), and Perez (2014).…”