In the last decades, several European health systems have abandoned their vertically integrated health care in favour of some form of managed competition (MC), either in a centralised or decentralised format. However, during a pandemic, MC may put health systems under additional strain as they are designed to follow some form of ‘organisational self-interest’, and hence face reduced incentives for both provider coordination (e.g. temporary hospital close down, change in the case-mix), and information sharing. We illustrate our argument using evidence for the Covid-19 pandemic outbreak in Italy during March and April 2020, which calls for the development of ‘coordination mechanisms’ at times of a health emergency.
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AbstractThe persistence of inequalities in health is a major policy concern in England, which was addressed by the new Labour government in 1997 through prioritising the curtailment of health inequalities as a policy goal. However, whether specific interventions have managed to attain their goals is a question for empirical welfare analysis to elucidate. This paper addresses two related questions: first, it empirically examines the dynamic patterns of inequalities in health in England from 1997 to 2007 by estimating concentration indexes of inequality over three measures of health, namely self-reported health, long standing illness and health limitations, calculated across different years of the Health Survey for England. Second, using regression-based decomposition analysis, we explore whether specifically prioritised areas (so-called "spearhead" local authority areas ranked in the bottom fifth on national health indicators) exhibit a different pattern of inequality in the years following a targeted intervention in 2005. Results suggest that patterns of health inequalities in England exhibit moderate variation from 1997 to 2007, although some improvement in self-assessed health inequalities is found.Importantly, patterns of inequality in prioritised (spearhead) areas are not found to be significantly different than health inequalities in non-spearhead areas.JEL codes: I12, C21
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