Conference Agenda

This study explores the policy implementation process of the long-term care (LTC) reform launched in Italy in 2021. Specifically, it focuses on the establishment and operation of Single Access Points (Punti Unici di Accesso, PUA) designed to deliver a unified needs assessment for citizens by integrating the work of local health authorities, municipalities, and the national social security agency. The research aims to investigate how different institutional actors, each pursuing distinct mandates within the LTC system, collaborate at the local level to operationalize national policy guidelines.

Our methodological approach combines action research and participant observation. Researchers are actively engaged in national-level discussions concerning the reform’s implementation and participate in local-level processes, allowing for a direct observation of governance dynamics and professional practices. In addition, two local case studies will be analyzed to provide in-depth insights into the models of integration emerging across different territorial contexts.

The core focus of the analysis is threefold. First, we examine the models of collaborative governance established between the institutional actors involved, assessing how responsibilities, decision-making processes, and coordination mechanisms are structured. Second, we investigate the forms of inter-professional collaboration between the diverse categories of practitioners working within the Single Access Points. Third, we analyze the models of service management adopted to deliver integrated assessment and access services, exploring how operational processes are organized to meet the reform’s objectives.

By adopting a multi-level perspective, the study seeks to understand how national policy prescriptions are interpreted, adapted, and enacted locally, shedding light on the factors that facilitate or hinder effective integration across institutional boundaries. Our findings aim to contribute to the broader literature on public service integration, collaborative governance, and the implementation of complex social policies, offering both theoretical insights and practical lessons for policymakers and managers engaged in LTC reforms.

The role of the market is one of the main dividing lines in politics. Marxists argue that free market capitalism tends to produce and reproduce inequality and ill health through poor material conditions. Liberals and conservatives, on the other hand, claim that capitalism is responsible for the great improvements in health that have occurred over the last century. They see capitalism as the main driver of economic growth, and thus as the critical condition for health improvement. The large literature on economic freedom has almost exclusively dealt with economic outcomes, and documenting mainly favourable impacts. But going beyond economic indicators, does economic freedom also promote well-being? Combining the most recent data available on economic freedom in Europe with individual data on subjective health, we asked the following two research questions: how is the economic freedom of a country related to the subjective health of its citizens, and is this relationship contingent upon a person’s social background? Economic freedom was measured by the following four components from the ‘Good Capitalist Governance Index’: legal system and property rights, sound money, freedom to trade internationally, and government integrity. These country indicators were linked with the European Social Survey in the period 2002-2020, allowing for a time-series cross-section analysis of more than 435,000 individuals from 34 countries. At the individual level, the analysis controlled for the respondents’ socio-demographic background, while the country-level variables included GDP per capita and unemployment rate. The results indicate that within-country increases in legal system and property rights is associated with health benefits, but only for those with high education. Within-country increases in freedom to trade is also associated with better health, and these health benefits seem to apply both education groups.

This study traces the evolution of the ‘(in)equality in health’ concept in parliament debates in Denmark from 1998 until 2024, exploring how the social determinants of health framework has been translated into policy discourse. Analyzing parliament speeches, government platform documents, party programs and major political agreements both qualitatively and quantitatively by coding parliament speeches using large language model, we show that while health inequalities have increasingly been framed ‘broadly’ as a complex issue acknowledging social determinants, the practical policy issues identified with health inequalities have increasingly ‘narrowed’ in on the issue of healthcare access and quality. As a paradoxical translation of the social determinants framework, the complexity of health inequalities has provided policymakers with a language to undermine the use of legislation for structural prevention. The Danish case is illustrative of a dilemma that warrants strategic consideration among proponents of the social determinants of health framework. First, while evidence catalogues may inspire broad, coordinated policy action, such catalogues may also serve as a resource to divert attention and prevent impactful action. Second, as funding infrastructure becomes tied to the pursuit of ‘what works’ within boundaries defined by policymakers, researchers stand at risk of producing evidence for political projects with limited potential to address health inequalities. Going further to highlight the plausible health equality gains of policies may assist to prevent political side-stepping.

Digital transformations in public administration are increasingly reshaping organisational structures and work processes. While digital technologies are often seen as catalysts for increasing efficiency and reducing bureaucratic complexity, empirical studies show that these transformations can also create new challenges (Mergel et al., 2019; Kuhlmann & Bogumil, 2021). Organisational theory sees paradoxes as inherent to such transformations (Kokshagina & Schneider, 2022), with digitalisation creating tensions at both the organisational and individual levels. These individual-level paradoxes refer to recurring tensions in specific contexts (Mazmanian et al., 2013). They arise when workplace technologies require behavioural adjustments to balance autonomy with constant availability, cope with information overload, and navigate reduced face-to-face interaction. These paradoxes show how digital transformation offers benefits such as flexibility and efficiency but also creates challenges such as excessive data and communication barriers (Kokshagina & Schneider, 2022).

Similar patterns emerge in social and service administration, where digitisation goes beyond automation and standardisation to demand new skills and create additional workloads. Previously less visible tasks such as system implementation, training, and process adaption add to this complexity (Dreas & Klenk, 2021; Ruiz Ben, 2021; Gräfe et al., 2024; Justesen & Plesner, 2024).

While existing research in public administration has predominantly addressed the external dimensions of digitalisation, such as its impact on public service delivery and interactions with citizens (e.g., Zanker, 2019; Schwab et al., 2019), and the bulk of research on paradoxes has focused on private organisations, the internal dynamics - in particular the impact of digitalisation on internal work processes and structures within central public administrations - remain largely underexplored (Klenk & Veit, 2025). Central public administrations, which play a key role in political governance, legislation, and policy implementation, are often described as status quo-oriented and resistant to reform (e.g., Veit, 2018, on federal administration). These resistance tendencies raise the question of how digitalisation affects such environments and whether the paradoxes of digitalisation, as discussed for private organisations, also play a role here.

This study examines the perceptions of senior civil service executives using data from the Political Administrative Elite (PAE) Survey 2025. It explores the impact of digitalisation on workload, efficiency and administrative complexity, considering demographic factors and hierarchical positions. A key focus is the paradox of inclusion and exclusion in relation to demographic characteristics and health status.

It is hypothesised that executives who perceive themselves as vulnerable - such as those with caregiving responsibilities or chronic health conditions - will experience digitalisation as a relief, particularly through the ability to work remotely. This flexibility could be seen as an inclusive opportunity to break down barriers for those with physical or family constraints. Conversely, executives with lower digital literacy or fewer digital resources may experience digitalisation as a burden, intensifying exclusionary dynamics.

Using multiple regression analysis, the study examines the relationship between digital literacy, perceived digitalisation and individual vulnerability. The findings aim to clarify whether digital technologies enhance efficiency or create new complexities, and whether they mitigate or reinforce structural inequalities in public administration.