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Divided We Survive? Multilevel Governance during the COVID-19 Pandemic in Italy and Spain

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  • Marta Angelici
  • Paolo Berta
  • Joan Costa-Font
  • Gilberto Turati

Abstract

We compare the intergovernmental health system responses to the first wave of COVID-19 pandemic in Italy and Spain, two countries, healthcare is managed at the regional level, and the impact of the first wave was highly localized. However, whilst in Italy the regional government allowed for a passively accepted central level coordination without restricting autonomy (‘coordinated autonomy’), in Spain, the health care system was de facto centralized under a ‘single command’ (‘hierarchical centralization’). We argue that the latter strategy gave rise to limited incentives for information sharing and regional participation in decision-making. This article documents evidence of important differences in health outcomes (infected cases and deaths) and outputs (regular and emergency hospital admissions) between the two countries, both at the national and at the regional level. We then discuss several potential mechanisms to account for these differences. Given the strong localized impact of the pandemic, allowing more autonomy in Italy compared to a centralised governance in Spain can explain some cross-country differences in outcomes and outputs.
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Suggested Citation

  • Marta Angelici & Paolo Berta & Joan Costa-Font & Gilberto Turati, 2023. "Divided We Survive? Multilevel Governance during the COVID-19 Pandemic in Italy and Spain," Publius: The Journal of Federalism, CSF Associates Inc., vol. 53(2), pages 227-250.
    • Handle: RePEc:oup:publus:v:53:y:2023:i:2:p:227-250.
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    File URL: http://hdl.handle.net/10.1093/publius/pjad002
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    1. Joan Costa-Font & Gilberto Turati, 2018. "Regional healthcare decentralization in unitary states: equal spending, equal satisfaction?," Regional Studies, Taylor & Francis Journals, vol. 52(7), pages 974-985, July.
    2. Mattia Casula & Serafín Pazos-Vidal, 2021. "Assessing the Multi-level Government Response to the COVID-19 Crisis: Italy and Spain Compared," International Journal of Public Administration, Taylor & Francis Journals, vol. 44(11-12), pages 994-1005, September.
    3. Costa Font, Joan & Levaggi, Rosella & Turati, Gilberto, 2022. "Resilient managed competition during pandemics: lessons from the Italian experience during COVID-19," Health Economics, Policy and Law, Cambridge University Press, vol. 17(2), pages 212-219, April.
    4. Joan Costa-Font & Ana Rico, 2006. "Devolution and the Interregional Inequalities in Health and Healthcare in Spain," Regional Studies, Taylor & Francis Journals, vol. 40(8), pages 875-887.
    5. Brenna, Elenka, 2011. "Quasi-market and cost-containment in Beveridge systems: The Lombardy model of Italy," Health Policy, Elsevier, vol. 103(2), pages 209-218.
    6. David Bailey & Jennifer Clark & Alessandra Colombelli & Carlo Corradini & Lisa De Propris & Ben Derudder & Ugo Fratesi & Michael Fritsch & John Harrison & Madeleine Hatfield & Tom Kemeny & Dieter F. K, 2020. "Regions in a time of pandemic," Regional Studies, Taylor & Francis Journals, vol. 54(9), pages 1163-1174, September.
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    Cited by:

    1. Sergi Jiménez-Martín & Analía Andrea Viola, 2021. "Cuarto Informe Observatorio de Sanidad de FEDEA," Studies on the Spanish Economy eee2021-31, FEDEA.

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    More about this item

    JEL classification:

    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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