Minori rumeni tra percorsi migratori e rappresentazioni. Nè soli, nè accompagnati a Bologna

The thesis deals with the heterogenous category of the “unaccompanied minors”, concentrating the scientific work on those who migrate from Romania to the Italian city of Bologna. Between different migratory routes that include Romanian minors, I chose to explore the ones linked with the underground and illegal contexts. In order to analyse the reasons and the morphology of their migratory career, I used the multisituated field research which allowed me to consider the social policies in both the Romanian and the Italian environment. The main debate on the situation of the “unaccompanied children” refers to the extent to which these minors leave their country of origin “accompanied” by different adult figures and it also involves the role played by these adults. The first chapter is dedicated to a brief theoretical and methodological introduction to the main arguments of the thesis such as Romanian migration to Italy, trafficking in human beings, transnationality of migrant’s migration and decentered cooperation as a means of contrasting illegal migration and trafficking. Each field of research is characterized by a specific methodological approach, but they are all linked by the anthropological perspective I adopted throughout the entire work. The Romanian context, analized from a diachronic and a synchronic perspective represents the object of the second chapter. Some aspects of the Regime policies and other characteristics of the Romanian poscomunist period of “transition” are useful frameworks that become a background of the migration flows outside the country. The third chapter focuses on the Romanian patterns of migration. The reconstruction of some past attitudes that Romanians adopted towards migration are relevant in order to reveal the continuity with the present migratory practices. A consistent part is dedicated to a concrete example based on a field research in Bologna on a group of Romanian roma migrating from the south of Romania. The contact with these persons opened a debate on the limits between legal and illegal migration practices among the Romanians. The conclusion is that minors’ migration to Italy follows the adult patterns and flows. The nucleus of the field researches is included in the fourth and the fifth chapter. Before presenting the settings and the itineraries of the field researches, some deconstructive reflections are made on the representations that common sense and social sciences create on concepts as “child”, “minor” and “childhood”. A first perspective on the Romanian migrant minors emerges from a research concentrated on a group of roma teenagers engaged in Bologna in activities like windscreen washing, pocket-picking, begging and street prostitution. The aim of the research was to gain access to their daily life, to observe their relationship with the adults who “accompany” them and the strategies they activate in order to take some material profit out of their migratory experience. A parallel field research focuses on the Romanian minors who are part of the roma group coming from the south of Romania. Most of them are reunited with their family in Bologna, but according to the Italian law, they are all living as illegal migrants. Others are only temporary sheltered by these families and they meanwhile dedicate to illegal survviving practices. An interesting point of my participant observation was to reveal the motivations that these minors give when asked about the refusal to start a legal career inside the local Centres dedicated to the “non accompanied minors”. Their autoreflexivity brings some light on the controversy regarding the adequacy of the local and national care system and the migratory projects the minors have. In this respect, a small part of the research is dedicated to the phenomena of minors’ street prostitution in Bologna, as a useful contribution to the fragmented vision researchers have on the “unaccompanied” or “separated” children. The last chapter focuses on a decentered cooperation project that emerged as an alternative response the local administration from Bologna had chosen for facing the presence of numerous migrants coming from the south of Romania. The group of Romanian roma who was also the object of my field research became the starting point for the cooperation proposals between the city of Bologna and the city of Craiova. Although there are three projects involving the two administrations, throughout a period of stage in the Romanian city of Craiova I chose to analyse, only the one dedicated to the “urgent measures” requested in order to contrast the illegal migration and the trafficking in minors. This final part of the thesis highlightens the possible contribution that such a project might bring to the study of a complex and in some parts contradictory phenomena as that of the “unaccompanied” migrant minors.

Mercato del lavoro e riforma della vigilanza pubblica

After having covered the international regulation in the labour market and in the control mechanisms fighting the irregular and the concealed labour, the Author concentrates on the Italian system’s answers to the requests coming from the European Union. Starting from the White Book on the labour market in Italy, the problems originated by the Legislative Decree 124/2004 and, moreover, those which have affected the fight against the concealed labour are dealt with. The aim study is to verify that the juridical regulation adopted by the national lawmaker has contributed to solve the problems connected to the labour flexibility and the consequent temporary employment. The analysis of the problems has led to the conclusion that, regardless the lawmaker’s good intentions, the basic principles of the national juridical system do not allow the achievement of a full realization of the objectives. This is mainly because the lack of effective systems to protect the flexible employees often treated as temporary employees, and because of the difficulties to introduce the legal culture on which the whole system should stand.

Quantifying the Economics of Medical Malpractice - A View from a Civil Law Perspective

Life is full of uncertainties. Legal rules should have a clear intention, motivation and purpose in order to diminish daily uncertainties. However, practice shows that their consequences are complex and hard to predict. For instance, tort law has the general objectives of deterring future negligent behavior and compensating the victims of someone else's negligence. Achieving these goals are particularly difficult in medical malpractice cases. To start with, when patients search for medical care they are typically sick in the first place. In case harm materializes during the treatment, it might be very hard to assess if it was due to substandard medical care or to the patient's poor health conditions. Moreover, the practice of medicine has a positive externality on the society, meaning that the design of legal rules is crucial: for instance, it should not result in physicians avoiding practicing their activity just because they are afraid of being sued even when they acted according to the standard level of care. The empirical literature on medical malpractice has been developing substantially in the past two decades, with the American case being the most studied one. Evidence from civil law tradition countries is more difficult to find. The aim of this thesis is to contribute to the empirical literature on medical malpractice, using two civil law countries as a case-study: Spain and Italy. The goal of this thesis is to investigate, in the first place, some of the consequences of having two separate sub-systems (administrative and civil) coexisting within the same legal system, which is common in civil law tradition countries with a public national health system (such as Spain, France and Portugal). When this holds, different procedures might apply depending on the type of hospital where the injury took place (essentially whether it is a public hospital or a private hospital). Therefore, a patient injured in a public hospital should file a claim in administrative courts while a patient suffering an identical medical accident should file a claim in civil courts. A natural question that the reader might pose is why should both administrative and civil courts decide medical malpractice cases? Moreover, can this specialization of courts influence how judges decide medical malpractice cases? In the past few years, there was a general concern with patient safety, which is currently on the agenda of several national governments. Some initiatives have been taken at the international level, with the aim of preventing harm to patients during treatment and care. A negligently injured patient might present a claim against the health care provider with the aim of being compensated for the economic loss and for pain and suffering. In several European countries, health care is mainly provided by a public national health system, which means that if a patient harmed in a public hospital succeeds in a claim against the hospital, public expenditures increase because the State takes part in the litigation process. This poses a problem in a context of increasing national health expenditures and public debt. In Italy, with the aim of increasing patient safety, some regions implemented a monitoring system on medical malpractice claims. However, if properly implemented, this reform shall also allow for a reduction in medical malpractice insurance costs. This thesis is organized as follows. Chapter 1 provides a review of the empirical literature on medical malpractice, where studies on outcomes and merit of claims, costs and defensive medicine are presented. Chapter 2 presents an empirical analysis of medical malpractice claims arriving to the Spanish Supreme Court. The focus is on reversal rates for civil and administrative decisions. Administrative decisions appealed by the plaintiff have the highest reversal rates. The results show a bias in lower administrative courts, which tend to focus on the State side. We provide a detailed explanation for these results, which can rely on the organization of administrative judges career. Chapter 3 assesses predictors of compensation in medical malpractice cases appealed to the Spanish Supreme Court and investigates the amount of damages attributed to patients. The results show horizontal equity between administrative and civil decisions (controlling for observable case characteristics) and vertical inequity (patients suffering more severe injuries tend to receive higher payouts). In order to execute these analyses, a database of medical malpractice decisions appealed to the Administrative and Civil Chambers of the Spanish Supreme Court from 2006 until 2009 (designated by the Spanish Supreme Court Medical Malpractice Dataset (SSCMMD)) has been created. A description of how the SSCMMD was built and of the Spanish legal system is presented as well. Chapter 4 includes an empirical investigation of the effect of a monitoring system for medical malpractice claims on insurance premiums. In Italy, some regions adopted this policy in different years, while others did not. The study uses data on insurance premiums from Italian public hospitals for the years 2001-2008. This is a significant difference as most of the studies use the insurance company as unit of analysis. Although insurance premiums have risen from 2001 to 2008, the increase was lower for regions adopting a monitoring system for medical claims. Possible implications of this system are also provided. Finally, Chapter 5 discusses the main findings, describes possible future research and concludes.

Medical Malpractice in Public Healthcare Systems: An Empirical Investigation of Scheduled Damages

In the last decades, medical malpractice has been framed as one of the most critical issues for healthcare providers and health policy, holding a central role on both the policy agenda and public debate. The Law and Economics literature has devoted much attention to medical malpractice and to the investigation of the impact of malpractice reforms. Nonetheless, some reforms have been much less empirically studied as in the case of schedules, and their effects remain highly debated. The present work seeks to contribute to the study of medical malpractice and of schedules of noneconomic damages in a civil law country with a public national health system, using Italy as case study. Besides considering schedules and exploiting a quasi-experimental setting, the novelty of our contribution consists in the inclusion of the performance of the judiciary (measured as courts’ civil backlog) in the empirical analysis. The empirical analysis is twofold. First, it investigates how limiting compensations for pain and suffering through schedules impacts on the malpractice insurance market in terms of presence of private insurers and of premiums applied. Second, it examines whether, and to what extent, healthcare providers react to the implementation of this policy in terms of both levels and composition of the medical treatments offered. Our findings show that the introduction of schedules increases the presence of insurers only in inefficient courts, while it does not produce significant effects on paid premiums. Judicial inefficiency is attractive to insurers for average values of schedules penetration of the market, with an increasing positive impact of inefficiency as the territorial coverage of schedules increases. Moreover, the implementation of schedules tends to reduce the use of defensive practices on the part of clinicians, but the magnitude of this impact is ultimately determined by the actual degree of backlog of the court implementing schedules.