IS ADMINISTERED COMPETITION SUITABLE FOR DEALING WITH A PUBLIC HEALTH EMERGENCY? LESSONS FROM THE LOCAL HEALTHCARE SYSTEM AT THE CENTRE OF EARLY COVID-19 OUTBREAK IN ITALY
IS ADMINISTERED COMPETITION SUITABLE FOR DEALING WITH A PUBLIC HEALTH EMERGENCY? LESSONS FROM THE LOCAL HEALTHCARE SYSTEM AT THE CENTRE OF EARLY COVID-19 OUTBREAK IN ITALY
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DOI：
10.21101/cejph.a6533
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发表时间：
2021-01-01
影响因子：
1.2
通讯作者：
Banfi, Giuseppe
中科院分区：
文献类型：
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作者：
Pennestri, Federico;Gaudioso, Antonio;Banfi, Giuseppe
目标：意大利伦巴第大区受COVID-19疫情影响最为严重。在缺乏有效治疗和强制性基本卫生措施的情况下，伦巴第对COVID-19的应对依赖于其医疗保健系统的特点、管理竞争或“准市场”模式。该研究的目的是审查伦巴第在第一波COVID-19疫情期间应对措施的优势和劣势，探讨医疗保健模式是否影响危机管理，并描述哪些政策有助于遏制未来的疫情爆发。研究结果有望为类似的医疗保健系统提供经验教训，以避免错误并从最佳实践中学习。研究方法：伦巴第和韦内托地区医疗保健系统绩效的定量分析数据来自现有的政府来源，包括意大利民防局和卫生部。结果：伦巴第准市场模式，传统上以强大的医院网络为特征，负责许多次优的结果。据批评人士说，多年来对社区护理的投资减少导致医院超负荷运转。然而，同样的模式也带来了其他积极的结果，这些结果在很大程度上被忽视了，例如有机会在安全的环境中测试有效的遏制治疗方法，并迅速扩大床位数量。结论：准市场模式应对突发公共卫生事件的绩效在很大程度上取决于政策制定者之间的整合和医疗服务提供者之间的平衡，这需要明确的监管。减少各级治理之间的机构分散，改善医疗保健设施的协调，采用远程医疗技术，是医疗保健网络可以
Objectives: The Lombardy Region, Italy, was the most severely affected by the COVID-19 outbreak. In absence of effective treatments and with basic hygiene measures made mandatory, Lombardy response to COVID-19 relied on its healthcare system characteristics, the administered competition or "quasi-market" model. The aim of the study was to review the strengths and weaknesses of Lombardy's response during the first wave of the COVID-19 epidemic, to explore whether the healthcare model influenced crisis management and describe which policies could help to contain future outbreaks. The results are expected to provide similar healthcare systems with lessons to avoid mistakes and learn from best practice. Methods: Data for quantitative analyses on the performance of the Lombardy and Veneto Regions healthcare systems were derived from existing government sources including the Italian Civil Protection Agency and the Ministry of Health. Results: Lombardian quasi-market model, traditionally characterized by a strong hospital network, was held responsible for many suboptimal outcomes. According to critics, years of disinvestments in community care resulted in a hospital overload. However, the same model was responsible for other positive outcomes which have been substantially neglected, such as the opportunity to test for effective containment treatments in a safe environment and rapidly extend the number of beds. Conclusions: The performance of a quasi-market model against public health emergencies largely depends on integration between policymakers and balance between healthcare providers, which require clear regulation. Reducing institutional fragmentation between levels of governance, improving the coordination of healthcare facilities and adopting telemedicine technologies are means by which healthcare networks could