Impact of austerity programs: Evidence from the Italian national health service.

Austerity measures are widely adopted to cope with financial straits. Since 2007 Italy has operated a financial recovery program (Piani di Rientro, PdR) in certain regions of the country. This provides an interesting setting for an intra-national analysis of the differences between the regions under a PdR program and those which are not. In the regions under a PdR, efforts to achieve economic sustainability and fiscal balance have impacted on healthcare indicators, resulting in a reduction in healthcare resources, an increase in taxes, and a general weakening of regional healthcare systems since the introduction of the program more than a decade ago. The detrimental effects of the austerity measures have become evident. As the regions under a PdR have demonstrated a sufficient level of economic stability, the national government should start revising its austerity strategy to prevent further widening of gaps in healthcare performance between regions.

Analysis of the Different Approaches Adopted in the Italian Regions to Care for Patients Affected by COVID-19.

As the Italian health system is regionally based, COVID-19 emergency actions are based on a general lockdown imposed by national authority and then management at local level by 21 regional authorities. Therefore, the pandemic response plan developed by each region led to different approaches. The aim of this paper is to analyze whether differences in patient management may have influenced the local course of the epidemic. The analysis on the 21 Italian regions considers the strategies adopted in terms of hospitalization, treatment in the ICU and at home. Moreover, an in-depth analysis was carried out on: Lombardia, which adopted a hospitalization approach; Veneto, which tended to confine patients at home; and Emilia Romagna, which adopted a mixed hospitalization-home based approach. The majority of regions implemented a home-based approach, while the hospital approach was followed in three regions (Lombardia, Piemonte, and Lazio), mainly limited to the first period of the outbreak. All regions in the later phases tended to reduce hospitalization, preferring to confine patients at home. This comparison, highlighting the different phases of the pandemic, outlined that the adoption of home-based practices contributed to limiting infection rates among patients and health professionals as well as decreasing the number of deaths.

No hospital is an island - emerging new roles of the acute general hospital in the Singapore healthcare ecosystem.

General hospitals in Singapore are undergoing a process of transformation, from being siloed providers of acute care, into vital hubs of a regional health system that integrates community and hospital-based care to meet the health and social needs of the population. Collaborations between the acute hospitals and other community providers, such as primary care and nursing homes, have been strengthened through clinical leadership supported by government policies that enable the sharing of key hospital clinical resources throughout the community. These collaborations have enabled better use of hospital resources while strengthening the capabilities of regional healthcare providers. Successful collaborations are propagated through the use of an intermediary enabling national agency. This paper outlines the journey that has been undertaken thus far and provides a few examples of how acute hospitals have begun to refocus their attention towards a new paradigm of care. The initial experiences and key lessons will be useful in the planning of a new 'greenfield' hospital campus designed from the 'ground up' which will embody these key principles of the hospital of the future.