The Italian NHS: What Lessons to Draw from COVID-19?
- PDF / 769,337 Bytes
- 4 Pages / 595.276 x 790.866 pts Page_size
- 77 Downloads / 153 Views
COMMENTARY
The Italian NHS: What Lessons to Draw from COVID‑19? Livio Garattini1 · Michele Zanetti1 · Nicholas Freemantle2
© Springer Nature Switzerland AG 2020
1 Introduction Italy was the first European country to be dramatically hit by the COVID-19 pandemic, recording the highest official number of victims in the world up to Easter 2020. Of course, this catastrophic event has put under pressure the Italian National Health Service (INHS), a Beveridge-type healthcare system characterized by universal coverage. Here, we first summarize the main characteristics of the INHS at an institutional level. Then we focus on the three health services most affected by the pandemic: (1) general practitioners (GPs), who were put under intense pressure by the population as a front-line service; (2) accident and emergency services (AEs) in hospitals, which were put under strain at the onset of the pandemic and were the sites of the first outbreaks; and (3) intensive care units (ICUs), which were overcrowded by severely ill patients at a later stage. Finally, we try to draw some lessons from this epochal experience, envisaging changes that could be potentially useful for improving the INHS performance, and hopefully that could be relevant to other European countries too.
2 Institutional Framework Italy has around 60 million inhabitants and a population density higher than that of most Western European countries, although unevenly distributed throughout its very extensive landmass, which includes the two large islands of Sardinia and Sicily. Italy is geographically divided into 20 regions (Fig. 1) governed by elected politicians, which vary a lot in terms of both size—from 3261 (Aosta Valley) to 25,832 * Livio Garattini [email protected] 1
Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, Via GB Camozzi 3, 24020 Ranica, BG, Italy
Institute of Clinical Trials and Methodology, University College London, London, UK
2
(Sicily) square kilometres—and population—from around 130,000 (Aosta Valley) to 10,000,000 inhabitants (Lombardy) [1]. Introduced in 1978, the INHS is a public service mainly funded by general taxation that provides universal coverage and comprehensive healthcare free at the point of use [2]. Unlike the UK NHS, the system is highly decentralized and the 20 regions are each legally responsible for planning services and allocating financial resources—health is by far the most important item of all regional budgets. Local autonomy implies financial accountability, which allows regions to develop substantially different health strategies without national endorsement [3]; it is a common view among experts that Italy has 20 NHSs. Conversely, a national policy is not necessarily applied by all regions homogeneously. So, the central and regional tasks have been intertwined in the last few decades on account of many piecemeal legislative measures issued by the quite numerous governments over time.
3 General Practice Unlike in other Western countries, there are two kind
Data Loading...
