Street-level workers, managers and institutional tensions: a comparative ethnography of healthcare practices of in/exclusion in three Italian public organisations

Roberta Perna

doi:10.1186/s40878-021-00224-6

Abstract

Public organisations are fundamental actors in migrant incorporation processes, as they are in charge of assessing migrants’ entitlement and providing access to welfare services. While a lot has been written on the individual determinants of street-level decisions, the role of organisational and institutional factors in shaping implementation practices has received little attention so far. By linking the street-level bureaucracy approach and the neo-institutionalist perspective in organisational analysis, this article investigates how public organisations mediate migrant incorporation processes in the field of healthcare. Drawing on a comparative ethnographic study of three public health organisations in an Italian region, the paper suggests that, in times of institutional tensions, managers’ priorities and framings of the issue, the ways they respond to decision-makers’ goals and allocate resources for implementing them, orient - and lead to variation in - street-level healthcare practices of in/exclusion for migrants with irregular status.

Highlights

Over the past decade, there have been significant advances in the field of migrant incorporation studies in Europe, focusing on both the macro-level of migration and integration policies and the micro-level of migrants’ individual trajectories and agency (Zincone et al 2011), as well as on the role played by different institutional and noninstitutional actors in the multi-level governance of migrant incorporation policymaking (Garcés-Mascareñas and Penninx 2016).In the realm of social rights, in particular, public organisations are of utmost importance, as they are in charge of assessing migrants’ welfare entitlements and providing access to social protection (Chauvin and Garcés-Mascareñas 2014)
Three clinics were purposefully sampled for the comparative purpose of the study to provide variation in the structural constraints identified by the street-level bureaucracy literature to explain street-level discretionary strategies (Brodkin 2012), namely the number of Migrants with irregular status (MIS) applying for healthcare and the organisational resources allocated by the management to the functioning of the service
Street-level practices, organisations, institutions: cutting across levels Drawing on a comparative ethnographic case study of three public health organisations in the Northern Italian region of Piemonte, this article investigated how organisations mediate the access to healthcare for MIS

Summary

Introduction

There have been significant advances in the field of migrant incorporation studies in Europe, focusing on both the macro-level of migration and integration policies and the micro-level of migrants’ individual trajectories and agency (Zincone et al 2011), as well as on the role played by different institutional and noninstitutional actors in the multi-level governance of migrant incorporation policymaking (Garcés-Mascareñas and Penninx 2016). Drawing on a comparative ethnographic study of three public health organisations in the Northern Italian region of Piemonte, this article analyses how organisations mediate healthcare incorporation processes of migrants with irregular status (hereafter: [MIS]), paying particular attention to the role played by organisations’ managers in orienting street-level workers’ practices. Three clinics were purposefully sampled for the comparative purpose of the study to provide variation in the structural constraints identified by the street-level bureaucracy literature to explain street-level discretionary strategies (Brodkin 2012), namely the number of MIS applying for healthcare (higher than/equal to/lower than regional average) and the organisational resources allocated by the management to the functioning of the service (more than/equal to/less than the minimum threshold set by the regional law).

Methods

Findings

Conclusions