Click here to download

Has healthcare rationalisation been rationale? Hospital beds and Covid-19 in Italy
Journal Title: SALUTE E SOCIETÀ 
Author/s:  Stefano Neri 
Year:  2021 Issue: suppl. 2 Language: English 
Pages:  19 Pg. 133-151 FullText PDF:  554 KB
DOI:  10.3280/SES2021-002-S1009
(DOI is like a bar code for intellectual property: to have more infomation:  clicca qui   and here 

The outbreak of Covid-19 pandemic highlighted the existence of a hospital bed shortage in Italy, as a result of a longstanding trend. The article analyses this process by an international comparison with other Western European countries, highlighting the intensity of hospital bed reduction in Italy, as a fundamental component of NHS rationalisation. Although it was based on solid grounds, international data suggest that hospital bed reduction was probably excessive, depriving the NHS of organisational slack. Moreover, de-hospitalisation would have been matched with a stronger development of primary and community care. The relative shortage of these services, along with the lack of integrated networks between hospital and non-hospital care, explains many difficulties experienced by hospitals in tackling Covid patients. Beyond investments in health care, these elements call to re-think the organisation of health care provision at local level, questioning the purchaser-provider split.
Keywords: hospital beds; hospital care; Covid-19; epidemiological transition; intensive care; primary care.

  1. Agenas (2021). L’analisi sulla capacità di resilienza del sistema sanitario nazionale nel suo complesso e delle sue componenti regionali durante il primo semestre 2020, Agenas, Roma.
  2. Altems (2021a). Analisi dei modelli organizzativi di risposta al Covid-19, Istant Report 8 luglio 2021, Altems - Università Cattolica del Sacro Cuore. -- Testo disponibile al sito: (11/07/2021).
  3. Altems (2021b). Sustainability and Resilience in the Italian Health System, Altems-Università Cattolica el Sacro Cuore and London School of Economics. -- Testo disponibile al sito: (11/07/2021).
  4. Bach S., Bordogna L. (2016). Public Service Management and Employment Relations in Europe. Emerging from the Crisis, London-New York: Routledge.
  5. Casula M., Terlizzi A., Toth F. (2020). I servizi sanitari regionali alla prova del COVID-19. Rivista Italiana di Politiche Pubbliche, Rivista quadrimestrale, 3: 307-36., DOI: 10.1483/9873
  6. Corte dei Conti (2021). Rapporto 2021 sul coordinamento della finanza pubblica, Corte dei Conti, Roma. -- Testo disponibile al sito: (11/07/2021).
  7. Enthoven A. (1985). Reflections on the Managment of the National Health Service. London: The Nuffield Provincial Hospital Trust.
  8. EU Commission (2015). Recruitment and Retention of the Health Workforce in Europe, European Commission, Brussels. -- Testo disponibile al sito: (10/07/2021).
  9. Eurofound (2020). Long-term care workforce: Employment and working conditions, Publications Office of the European Union, Luxembourg. -- Testo disponibile al sito: (10/07/2021).
  10. Froud J., Haslam C., Johal S., Law J., Williams K. (2020). When Systems Fail UK acute hospitals and public health after Covid-19, Research Report, Foundational Economy Collective, June 2020. -- Testo disponibile al sito: (2/05/2021).
  11. Giarelli G. (2017). 1978-2018: quarant’anni dopo. Il Ssn tra definanziamento, aziendalizzazione e regionalizzazione. Autonomie Locali e Servizi Sociali, 40 (3): 455-482.
  12. Bologna: Fondazione Gimbe. -- Testo disponibile al sito: (05/05/2021).
  13. Klein R. (2013). The New Politics of the Nhs. From Creation to Reinvention. Boca Raton: Crc Press.
  14. Le Grand J., Bartlett W., (a cura di) (1993). Quasi-Markets and Social Policy, London: MacMillan Springer.
  15. March J., Simon H.A. (1958). Organizations. New York: John Wiley.
  16. (eds), The Italian welfare state in a European perspective, Bristol: Policy Press.
  17. Vicarelli G., Pavolini E. (2015). Health Workforce Governance in Italy. Health Policy, 119(12): 1606-12.
  18. Ministero della Salute (2001). Attività gestionali ed economiche delle Asl e delle Aziende ospedaliere. Annuario statistico del Servizio Sanitario Nazionale. Anno 2000, Roma, Ministero della Salute. -- Testo disponibile al sito: (01/05/2021).
  19. Ministero della Salute (2011). Attività gestionali ed economiche delle Asl e delle Aziende ospedaliere. Annuario statistico del Servizio Sanitario Nazionale. Anno 2008, Roma, Ministero della Salute. -- Testo disponibile al sito: (01/05/2021).
  20. Ministero della Salute (2020). Assetto organizzativo, attività e fattori produttivi del SSN. Annuario statistico del Servizio Sanitario Nazionale. Anno 2020, Ministero della Salute, Roma. Testo disponibile al sito: C_17_pubblicazioni_2980_allegato. pdf ( (01/05/2021).
  21. Mohan L. (2002). Planning, Markets and Hospitals. London: Routledge.
  22. Neri S. (2019). The Italian National Health Service after the Economic Crisis: From Decentralization to Differentiated Federalism. E-Cadernos Ces, 31:147-169.
  23. Neri S. (2020). Più Stato e più Regioni. L’evoluzione della governance del Servizio sanitario nazionale e la pandemia. Autonomie Locali e Servizi Sociali, 2:239-55., DOI: 10.1447/9871
  24. Neri S., Turati G. (2009). Processi di riorganizzazione della rete ospedaliera: ragioni teoriche, evidenze empiriche e fattori di successo. Il caso della riconversione dei piccoli ospedali in Emilia-Romagna. In: Bosi P., Dirindin N., Turati G., a cura di, Decentramento fiscale, riorganizzazione interna ed integrazione sociosanitaria: le nuove sfide dei sistemi sanitari regionali. Milano: Vita & Pensiero.
  25. Oecd (2016). Health Workforce Policies in OECD Countries. Right Jobs, Right Skills, Right Places, Oecd, Paris. -- Testo disponibile al sito: https://read.oecd-ilibrary. org/social-issues-migration-health/health-workforce-policies-in-oecdcountries_9789264239517-en#page1 (11/07/2021).
  26. Oecd (2020a). Oecd Health Statistics 2020, Oecd, Paris. -- Testo disponibile al sito: (08/07/2021).
  27. Oecd (2020b). Empowering the health workforce. Strategies to make the most of the digital revolution. -- Testo disponibile al sito: (10/07/2021).
  28. Omran A.R (2005). The epidemiological transition: A theory of the epidemiology of population change. The Milbank Quarterly, 83 (4): 731-757.
  29. Perrow C. (1999). Normal Accidents: Living with High Risk Technologies. Princeton and Chicester: Princeton University Press.
  30. Pierson P. (1998). Irresistible Forces, Immovable Objects: Postindustrial Welfare States Confront Permanent Austerity. Journal of European Public Policy, 4: 539-560., DOI: 10.1080/1350176988000001
  31. Saltman R., Von Otter C. (1993). Planned Markets and Public Competition: Strategic Reform in Northern European Health Systems. Windmills: Sage.
  32. Sanfelici M. (2020). The Italian Response to the COVID-19 Crisis: Lessons Learned and Future Direction in Social Development. The International Journal of Community and Social Development, 2 (2): 191-210., DOI: 10.1177/251660262093603
  33. Starfield B. (1994). Is primary care essential?. Lancet, 344:1129-33.
  34. 10.1016/S0140-6736(94)90634-3
  35. Thompson J.D. (1967). Organizations in Action: Social Science Bases of Administrative Theory. London and New York: Routledge.
  36. Vicarelli G. (2015). Healthcare: difficult paths of reform, in Ascoli, U., Pavolini E.
  37. WHO (2020). Appropriateness in Health Care Services, Report on a WHO Workshop, World Health Organization, Geneva.
  38. WHO-EUROPE (2021). COVID-19 Health Systems Response Monitor, World Health Organization, EU Commission and European Observatory on Health Systems and Policies. -- Testo disponibile al sito: (03/05/2021).

Stefano Neri, in "SALUTE E SOCIETÀ" suppl. 2/2021, pp. 133-151, DOI:10.3280/SES2021-002-S1009


FrancoAngeli is a member of Publishers International Linking Association a not for profit orgasnization wich runs the CrossRef service, enabing links to and from online scholarly content