Abstract
Background. Providing healthcare services to vulnerable populations (VP) represents a priority, as they experience extreme health inequities1. However, VP are often hard to reach, especially for the National Healthcare Services (NHS). Therefore, in several countries, voluntary, community, and social enterprise organizations (VCSEOs) offer services to them, resulting in positive implications in terms of access, use of healthcare services, and ultimately health2. As such, collaboration among VCSEOs and between VCSEOs and the NHS is needed. Several works have studied the policy implementation gaps of VCSEOs involvement in integrated care3, while highlighting the need to better investigate the settings where regulated integration initiatives have been lacking, which is the case of Italy.
Objectives and methodology. Our study aims to analyse: i) the main characteristics of VCSEOs’ healthcare services and their level of specialisation; ii) the collaboration among VCSEOs, and related criticalities and opportunities; iii) the level and typologies of interactions between VCSEOs and NHS, and related criticalities and opportunities. We use a mixed methodology to collect information from 10 VCSEOs in Milan (Italy) with semi-structured interviews, a survey, and a workshop. We adopted qualitative thematic analysis, descriptive statistics and network analysis.
Results. Our research shows the heterogeneity of VCSEOs in terms of attenders, workforce organization and types of healthcare services, pointing to their relative specialisation. The differences between VCSEOs are perceived as opportunities rather than criticalities, as they bring mutual learning, enrichment and complementarity. These results, together with VCSEOs’ collaborations being mostly in place through informal channels, point to the necessity and opportunity of establishing a structured network. Looking at the interactions with the NHS, results show that VCSEOs have found different ways to ‘fill in the space’ left empty by NHS concerning: 1) whether VCSEOs’ services are substitutive or residual with respect to NHS ones; 2) the scope of VCSEOs interventions, in terms of services and target; 3) the origin of VCSEOs’ mandate. As of now, there is no structured governance of the interdependencies between VCSEOs and NHS, thus calling for its design through shared strategic governance, digital interoperability, integrated pathways, and workforce involvement.
Conclusion. Our research sheds some light on the criticalities and opportunities related to the organisation of the interdependencies among VCSEOs and between them and the NHS, paving the way for the development of best practices on how to design integrated and coordinated networks of private and public healthcare services for vulnerable populations.
References:
1.Aldridge RW, Story A, Hwang SW, Nordentoft M, Luchenski SA, Hartwell G, et al. Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis. The Lancet. 2018 Jan;391(10117):241–50.
2.Listorti E, Torbica A, Cella SG, Fiorini G, Corrao G, Franchi M. A Cohort Study on Diabetic Undocumented Migrants in Italy: Can Charitable Organizations Contribute to Higher Adherence? IJERPH. 2023 Feb 4;20(4):2794.
3.Croft C, Currie G. Realizing policy aspirations of voluntary sector involvement in integrated care provision: Insights from the English National Health Service. Health Policy. 2020 May;124(5):549–55.