The social economy and healthcare services: new challenges for the welfare system
42,845 social economy organisations active in Italy in the healthcare and social services sector, more than 566,000 people employed and a widespread presence in social and healthcare services: these are some of the first findings emerging from the research project “The Social Economy in supporting healthcare services in Italy”, promoted by EURICSE and funded by the Italian Ministry of University and Research. After the completion of its first year of activities, the study examines the contribution of the social economy to socio-health integration through an interdisciplinary approach combining data analysis, legal research, a national survey and an in-depth study of local good practices.
The study, coordinated by EURICSE researchers Sara Depedri, Eddi Fontanari, Michele Mazzetti, Jessica Pezzaioli and Giacomo Pisani, is now entering the empirical analysis phase and is investigating the role of social economy organisations in health promotion, the integration of social and health services, and the development of community-based services. Having established the theoretical and methodological framework, the research team conducted a national survey and began analysing significant local-level case studies. As part of the research, initial analyses of Istat data for 2023 were carried out, providing a snapshot of the social economy’s presence within the Italian welfare and care system. In Italy, there are 42,845 organisations active in the social and healthcare sector – including associations, co-operatives and foundations – with an average density of 7.3 organisations per 10,000 inhabitants. The organisations analysed employ a total of over 566,000 staff, comprising both employees and external contractors, confirming the social economy’s contribution to health and social services. The data highlight a particularly significant role played by the social economy in social care: almost 60 per cent of organisations operate in non-residential services, whilst over 5,000 organisations are involved in residential care. Their presence in healthcare is also significant, accounting for 28.3% of the organisations analysed.
In terms of legal form, associations predominate, accounting for 71.8% of the organisations analysed (30,779 organisations) and playing a significant role in community-based services. These are followed by social cooperatives, which account for 18.4% of the total (7,876 organisations) but which, however, play a particularly significant role in terms of employment, with over 370,000 workers involved. Foundations account for 6% of organisations, whilst other co-operatives account for 1.1% . A comparison with previous years also highlights an initial trend of interest: whilst the number of third sector organisations has tended to stabilise in the post-pandemic period, falling from 47,461 in 2019 to 42,845 in 2023, the total number of people employed in the social economy has risen, increasing from 529,427 jobs in 2019 to 566,321 in 2023 (+7% ).
These initial quantitative findings should be viewed against a backdrop characterised by the growing complexity of care needs and the transformation of local welfare systems. The research analyses the role of the social economy in the light of two major processes: on the one hand, the evolution of the population’s health and social needs; on the other, the implementation of Ministerial Decree 77/2022 on the reform of local care services.
“With regard to the needs assessment”, explain the researchers at EURICSE, “it is not only the progressive ageing of the population that is evident – with a 15.3 per cent increase in the ageing index between 2019 and 2024 – but also the rise in new care and health needs, which are becoming increasingly significant even amongst younger age groups. A significant example is the rate of hospital admissions for mental health issues among pre-adults, which rose by 51.5 per cent over the same period.” In the face of these changes, Italian spending on social protection for health and sickness has grown at a slower rate than the European average, making it all the more urgent to strengthen the integration of social and health care and local services. In this context, Community Centres represent a central element of the reform, but their implementation risks following different models: ranging from simple local healthcare facilities to genuine community infrastructures capable of promoting health, reducing inequalities and enhancing local networks. ‘The considerable autonomy granted to regional and autonomous provincial planning could lead to a fragmentation of interventions,’ emphasise the researchers at EURICSE.
In its first year of operation, the research project carried out a national survey involving over 700 social economy organisations, gathering information on areas of intervention, organisational models and relations with public authorities. Initial findings reveal a still significant gap between the potential contribution of the social economy and its actual involvement in social and healthcare integration processes: 40% of participating organisations state that, in recent years, they have not been involved in co-design processes for services or in structured forms of social and healthcare collaboration. At the same time, the project is examining a number of local initiatives in greater depth through the analysis of good practices and field interviews. The research will continue in the second year with the analysis of the data collected and will conclude in the first half of 2027 with dissemination activities and discussions with local institutions and stakeholders.
