Resilient managed competition during pandemics: lessons from the Italian experience during COVID-19

Area of Science:

• Health Policy and Management
• Public Health
• Healthcare Economics

Background:

• European health systems have increasingly adopted managed competition (MC) models, moving away from vertical integration.
• Managed competition models are designed around organizational self-interest, potentially impacting system-wide coordination.
• The COVID-19 pandemic exposed vulnerabilities in healthcare systems globally.

Purpose of the Study:

• To analyze the impact of managed competition (MC) on healthcare system performance during a pandemic.
• To identify challenges in provider coordination and information sharing within MC frameworks during health emergencies.
• To advocate for the development of specific coordination mechanisms for pandemic preparedness.

Main Methods:

• Qualitative analysis of healthcare system structures in Europe.
• Case study of the COVID-19 outbreak in Italy (March-April 2020).
• Review of theoretical frameworks of managed competition and organizational behavior.

Main Results:

• Managed competition models may create barriers to essential provider coordination during pandemics.
• Reduced incentives for information sharing and collaborative actions were observed.
• The Italian COVID-19 response highlighted the strain on systems with MC structures.

Conclusions:

• Managed competition healthcare systems may face significant challenges during health emergencies.
• The inherent 'organizational self-interest' in MC can impede necessary pandemic response coordination.
• Developing robust 'coordination mechanisms' is crucial for enhancing health system resilience during emergencies.