Divided We Survive? Multi-Level Governance during the Covid-19 Pandemic

Marta Angelici, Paolo Berta, Joan Costa-i-Font and Gilberto Turati (gilberto.turati@unicatt.it)
Authors registered in the RePEc Author Service: Joan Costa-i-Font

No 8999, CESifo Working Paper Series from CESifo

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.

Keywords: Covid-19; health system governance; decentralization; Italy; Spain; State of Alarm (search for similar items in EconPapers)
JEL-codes: H75 I18 (search for similar items in EconPapers)
Date: 2021
New Economics Papers: this item is included in nep-eur and nep-hea
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (1)

Downloads: (external link)
https://www.cesifo.org/DocDL/cesifo1_wp8999.pdf (application/pdf)

Related works:
Journal Article: Divided We Survive? Multilevel Governance during the COVID-19 Pandemic in Italy and Spain (2023)
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:ces:ceswps:_8999

Access Statistics for this paper

More papers in CESifo Working Paper Series from CESifo Contact information at EDIRC.
Bibliographic data for series maintained by Klaus Wohlrabe (wohlrabe@ifo.de).