A Tale of Two Pandemics in Three Countries

Abstract

Abstract Issue Italy, Spain, and Portugal's health systems are financed through general taxation, are generally free at the point of care, and provide universal health coverage. The three national health systems emerged in the late 1970s, in Italy as the result of the collapse of the previous social health insurance system and in Spain and Portugal as part of their democratization. They share some standard organizational and performance features that constitute potential strengths and vulnerabilities when facing a pandemic event. Description One of the most salient of these features is the impact of a decade of fiscal austerity. During the Great Recession and the Eurozone crisis, the governments of Italy, Spain, and Portugal decreased the budget available for health care, leading to cuts in long-term infrastructure investments and making it even more difficult to deal with the problem of workforce. Results Compared with northern European countries, these countries have very efficient healthcare systems. In other words, the return in terms of population health is very good for every Euro invested. Lessons However, in what is only apparently a paradox, efficiency is not an advantage during a pandemic. If all the resources are fully optimized, any significant surges in demand, such as those experienced during early March 2020 in Italy and Spain, this favors a collapse of the health system. Portugal seemed especially vulnerable, as it had the lowest number of intensive care unit beds per inhabitant in Europe and one of the lowest levels of investment in public health services in Europe. Main messages In 2015, on average, the countries of the Organization for Economic Co-operation and Development (OECD) allocated 2.8 percent of their total healthcare budget to health promotion and disease prevention. More investment in health promotion is a need strategy to drive countries over critical conditions.