Resistance to change. The problem of high non-take up in implementing policy innovations in the Italian long-term care system

Abstract

This article illustrates how the implementation of ‘interstitial’ innovation in welfare policy can be hampered by resistance to change on the part of its intended beneficiaries by means of a case study of a policy innovation in long-term care in Italy: the Home Care Premium (HCP) programme. In a policy area characterised by long-standing institutional inertia, HCP represents an innovative programme which provides a generous, conditional cash-for-care benefit to encourage the regular employment of in-house care assistants. However, the implementation of the scheme was hampered by high non-take up (NTU) rates, i.e. the percentage of beneficiaries who did not claim the cash-for-care benefit for which they were eligible. The article uses a ‘mixed method’ approach to show how high NTU rates can be explained by individually ‘situated’ decisions taken by the intended beneficiaries based on cost-benefit evaluations that are deeply rooted in social attitudes and adaptive practices shaped by the existing institutional context. The study also shows how the policy design of the programme partially failed to manage the institutional complementarity of different welfare programs effectively, thus weakening the capacity of this ‘interstitial’ policy to bring about policy innovation. The results of the case study may therefore be of interest to scholars interested in policy change and the role played by beneficiaries in policy implementation. Abbreviations: non-take up (NTU); long-term care (LTC).