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Divided We Survive? Multi-level Governance and policy uncertainty during the first wave of COVID-19

Author

Listed:
  • Angelici, M.
  • Berta, P.
  • Costa-Font, J
  • Turati, G.

Abstract

We compare health system responses to the first wave of COVID-19 pandemic in Italy and Spain. Although in both countries, healthcare is managed at the regional level, the central government behaved differently in the uncertainty surrounding the first wave, leaving more autonomy to regional governments in Italy than in Spain. Upon documenting evidence of national and regional health system responses, we show important differences in the number of infected cases, alongside regular and emergency hospital admissions, and mortality in the two countries, both at the national and at the regional level. We then discuss several potential mechanisms, such as policy stringency, the localization of the pandemic and mobility restrictions, measurement error, and especially the regional autonomy, enjoyed by Italian regions but not by Spanish regional governments amidst a state of alarm in both countries. We conclude that, given the strong localized effect of the pandemic, allowing more autonomy, and fostering experimentation and local solutions explains the gap between Italy and Spain in the first wave of the pandemic.

Suggested Citation

  • Angelici, M. & Berta, P. & Costa-Font, J & Turati, G., 2021. "Divided We Survive? Multi-level Governance and policy uncertainty during the first wave of COVID-19," Health, Econometrics and Data Group (HEDG) Working Papers 21/19, HEDG, c/o Department of Economics, University of York.
    • Handle: RePEc:yor:hectdg:21/19
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    References listed on IDEAS

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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. 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.
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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

    Keywords

    regional health systems; decentralization; policy stringency; health care; COVID-19; Italy; Spain;
    All these keywords.

    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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