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Waitzberg R, Hernández-Quevedo C, Bernal-Delgado E, Estupiñán-Romero F, Angulo-Pueyo E, Theodorou M, Kantaris M, Charalambous C, Gabriel E, Economou C, Kaitelidou D, Konstantakopoulou O, Vildiridi LV, Meshulam A, de Belvis AG, Morsella A, Bezzina A, Vincenti K, Figueiredo Augusto G, Fronteira I, Simões J, Karanikolos M, Williams G, Maresso A. Early health system responses to the COVID-19 pandemic in Mediterranean countries: A tale of successes and challenges. Health Policy 2021; 126:465-475. [PMID: 34711444 PMCID: PMC8507573 DOI: 10.1016/j.healthpol.2021.10.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 09/24/2021] [Accepted: 10/08/2021] [Indexed: 11/17/2022]
Abstract
This paper conducts a comparative review of the (curative) health systems' response taken by Cyprus, Greece, Israel, Italy, Malta, Portugal, and Spain during the first six months of the COVID-19 pandemic. Prior to the COVID-19 pandemic, these Mediterranean countries shared similarities in terms of health system resources, which were low compared to the EU/OECD average. We distill key policy insights regarding the governance tools adopted to manage the pandemic, the means to secure sufficient physical infrastructure and workforce capacity and some financing and coverage aspects. We performed a qualitative analysis of the evidence reported to the 'Health System Response Monitor' platform of the European Observatory by country experts. We found that governance in the early stages of the pandemic was undertaken centrally in all the Mediterranean countries, even in Italy and Spain where regional authorities usually have autonomy over health matters. Stretched public resources prompted countries to deploy "flexible" intensive care unit capacity and health workforce resources as agile solutions. The private sector was also utilized to expand resources and health workforce capacity, through special public-private partnerships. Countries ensured universal coverage for COVID-19-related services, even for groups not usually entitled to free publicly financed health care, such as undocumented migrants. We conclude that flexibility, speed and adaptive management in health policy responses were key to responding to immediate needs during the COVID-19 pandemic. Financial barriers to accessing care as well as potentially higher mortality rates were avoided in most of the countries during the first wave. Yet it is still early to assess to what extent countries were able to maintain essential services without undermining equitable access to high quality care.
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Affiliation(s)
- Ruth Waitzberg
- The Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Israel; Department of Health Care Management, Faculty of Economics & Management, Technical University Berlin, Germany.
| | | | - Enrique Bernal-Delgado
- Data Sciences for Health Services and Policy Research. Institute for Health Sciences in Aragon (IACS), Spain
| | - Francisco Estupiñán-Romero
- Data Sciences for Health Services and Policy Research. Institute for Health Sciences in Aragon (IACS), Spain
| | - Ester Angulo-Pueyo
- Data Sciences for Health Services and Policy Research. Institute for Health Sciences in Aragon (IACS), Spain
| | | | - Marios Kantaris
- American University of Cyprus, Larnaca, Health Services Research Centre
| | | | | | - Charalampos Economou
- Department of Sociology, Panteion University of Social and Political Sciences, Athens, Greece
| | - Daphne Kaitelidou
- Center for Health Services Management and Evaluation, Department of Nursing, National and Kapodistrian University of Athens, Greece
| | - Olympia Konstantakopoulou
- Center for Health Services Management and Evaluation, Department of Nursing, National and Kapodistrian University of Athens, Greece
| | | | - Amit Meshulam
- The Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Israel
| | - Antonio Giulio de Belvis
- Department of Life and Public Health Sciences, Catholic University of the Sacred Heart, Rome, Italy; Critical Pathways and Outcomes Evaluation Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Alisha Morsella
- Department of Life and Public Health Sciences, Catholic University of the Sacred Heart, Rome, Italy; Critical Pathways and Outcomes Evaluation Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | | | | | - Gonçalo Figueiredo Augusto
- NOVA National School of Public Health, Universidade NOVA de Lisboa; Comprehensive Health Research Center, Universidade NOVA de Lisboa; Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa
| | - Inês Fronteira
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa
| | - Jorge Simões
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa
| | | | - Gemma Williams
- European Observatory on Health Systems and Policies, Spain
| | - Anna Maresso
- European Observatory on Health Systems and Policies, Spain
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