La co-produzione della salute negli istituti di pena. L’applicazione di nuovi approcci di assistenza nel sistema sanitario penitenziario

This paper examines co-production in the delivery of care services within the penitentiary setting, where patient involvement is decisive in order to improve the effectiveness and the efficiency of penitentiary health care. User involvement is understood as an intrinsic attribute of public services; however, to be put into practice it requires a strong support at both institutional and cultural levels. This is especially true when the provision of health services is concerned. In fact, patient-provider relationships are generally affected by information asymmetry and psychological weakness perceived by patients. Besides, in the penitentiary environment the patient-provider relationship is influenced by the contingencies in which the provision of care is performed. On the one hand, providers are likely to mistrust their patients, turning out to be unwilling to involve them in the provision of care. On the other hand, inmates are likely to conceive health care settings as an opportunity to temporarily escape the detention rules, showing an inappropriate access to them. This article provide evidence on the willingness of penitentiary health care professionals to adopt a patient-centered approach to care. Organizational hostility discourages the introduction of co-production in the penitentiary setting, paving the way for organizational inertia.