Il finanziamento e la spesa

[Machine translation] Objectives The study analyzes the ways in which social and social health spending for the elderly who are not self-sufficient is financed in Lombardy. In particular, it focuses on three points: i) the funding flows for expenditure dedicated to the elderly and the competent bodies dedicated to their management; ii) the services provided respectively by the Municipalities and the Region and the expenditure generated by them; iii) the peculiarities of the Lombard model, the merits and the critical issues. The final objective is twofold: to analyze the trend in spending for the elderly in recent years and to outline a general picture of its allocation between social and social health areas and between the different types of services, respectively. Based on these results, it is possible to provide some indications in terms of the appropriateness of interventions and the satisfaction of the needs of the elderly who are not self-sufficient. Method and aspects discussed The analysis is developed on an institutional and quantitative level. After identifying the main institutional bodies that manage financial flows for elderly care, the numerical data (financing and expenditure) are reconstructed using different sources: the ISTAT database for municipal social spending (2011), the Social Budget and the 2013 Budget Indicators Plan for social and health expenditure managed by the Region. There are objective difficulties in the reconstruction of regional data concerning spending for the elderly, due to three main causes: i) the heterogeneity of the sources of funding that are spread over the three different levels of government, central, regional and municipal ii) the frequent overlap between social area and social health area, a factor that makes it difficult to correctly identify the items of expenditure, iii) the coexistence of different categories of users financed by social and social health spending (e.g. minors, immigrants, the elderly), the fact that involves frequent changes in the distribution of expenditure depending on priorities. Add to this, for Lombardy, the difficulty of accessing and the lack of transparency of regional budget data. It was therefore necessary to cross the data from the different sources and, in many cases, to reconstruct the items of expenditure starting from the type of services, through bottom-up techniques. The processed data are read in a comparative key at an interregional level.