Decentralization, policy capacities, and varieties of first health response to the COVID-19 outbreak: evidence from three regions in Italy

ABSTRACT

Effective response to a pandemic depends not only on national dynamics and characteristics but also on the features of a country’s political and administrative decentralization and on the organizational capacities of the health system. As a result, different policy capacities can be present in the same national health system, and this variance allows us to understand local policy actions and their outcomes. Based on this assumption, this paper compares the process and the content of the initial policy response in three Italian regions (Lombardy, Veneto, and Emilia-Romagna). These three regions simultaneously experienced the most intense diffusion of infections and adopted very different strategies to mitigate the transmission of the virus. Our comparison reveals how the characteristics of Italy’s decentralized health system and the consequent differentiation in terms of health policy capacities have clearly driven very different regional first health policy responses and outcomes with regard to dealing with the spread of COVID-19.

KEYWORDS:

• COVID-19
• policy capacity
• Varieties of responses
• decentralization
• Italy

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 Riccardo et al. (2020) show that some slight differences notwithstanding, the reproduction number (R0) in the three analysed regions was the highest throughout the country: for Lombardy, it was 2.96; for Emilia-Romagna, it was 2.84; and for Veneto, it was 2.54.

2 The data are still problematic here, but various estimations, including by the National Institute of Statistics, hold that the number of deaths in the province of Bergamo could in reality be double the official count of deaths due to COVID-19 (ISTAT, 2020).

Additional information

Notes on contributors

Giliberto Capano

Giliberto Capano is Professor of Political Science and Public Policy at the University of Bologna.

Andrea Lippi

Andrea Lippi is Professor of Political Science and Public Policy at the University of Florence.