Public Health Investment Research Articles

11.H. Round table: Making the case for public investment in health

Abstract Across the European Union (EU), public budgets are facing pressures and policy makers are becoming increasingly concerned about how to adequately and sustainably fund their health systems to keep up with need and demand. In recognition of this, in 2022 a Technical Support Instrument (TSI) project funded by the Directorate-General for Structural Reform Support (DG REFORM) was launched together with three European Union (EU) Member States with the goal of strengthening capacity to make the case for public investments in health. To support these efforts, the European Observatory on Health Systems and Policies (OBS) conducted an exercise to map relevant analytical approaches and tools for making the case for public investment in health. As a contribution to this workshop, OBS will present the key results from this exercise, including a framework that has been designed to support health policy makers, advisors and advocates by providing five key lines of argument and selected examples of tools, data, indicators and methods that can be used to successfully make the case for public funding for health. This will be complemented by two presentations on country experiences (in Austria and Malta) of navigating negotiations between health and finance and securing public funding for health. These will highlight both successes and challenges in practice. By looking at examples from MS on making the case for public investment in health, these presentations will frame the panel discussion that follows. The chairs will facilitate a discussion closely engaging the audience on how to build better narratives and exchanges which facilitate trust and alignment between health and finance stakeholders in the pursuit of strengthening the capacity to make the case for public investment in health. The workshop will highlight five lines of argument and practical examples of tools, data, indicators and methods that can be used to support the case for public investment in health. It will also focus on the important enablers (e.g. cooperation, communication, transparency, accountability, trust) for successful budget negotiations and discuss how these can be facilitated. Key messages • Budget cases for public funds for health tend to be most successful when they align well with the goals and objectives of finance stakeholders, and certain narratives and arrangements can foster this. • Data and evidence can help steer decision makers to make good choices (or at least avoid bad ones), but other factors serve as the fuel to push the budget case for health forward successfully. Speakers/Panelists Rebecca Forman European Observatory on Health Systems and Policies, London, UK Jonathan Cylus European Observatory on Health Systems and Policies, London, UK Stefan Eichwalder Ministry of Health, Vienna, Austria Neville Calleja Department of Health Information and Research, G’Mangia, Malta

10.A. Round table: Transforming public health systems at large scale: no pain, no gain

Abstract The COVID-19 pandemic, acceleration of climate change, and geopolitical turmoil have triggered discussions about how public health systems in Europe need to transform to be adequately equipped for the so-called “permacrisis”. The challenges to policy makers, health institutions and health services have become so multifaceted, that single solutions from the health sector alone no longer work. Yet, despite the complexity, countries seek to get its own house in order whilst building on inter-sectoral and European approaches in parallel. Germany, Ireland, and Ukraine have all embarked upon ambitious public health services and institutional reforms, leading to transformative change in public health systems. WHO has been accompanying these reforms. The workshop will provide a platform to draw insights and lessons on transforming public health systems from all three countries, although their population size, their socioeconomic and political situation and their public health system design is so different. As the smallest of the three countries in population, Ireland created coherence and is aligning public health actors within “Healthy Ireland” and the Sláintecaire and the Crowe Horwath public health reforms. Germany’s “Pact for the Public Health Services” has been one of the greatest public health investment programs in Europe that was initiated following lessons from the COVID-19 pandemic. And Ukraine has undertaken important legal steps to adopt a Public Health System Law, in the middle of a war of aggression on its territory. The workshop will exhibit the process of large-scale public health system transformation in each of the three countries. The purpose is to identify the enablers that make large scale system transformation possible and addressing some of the pains and gains. The workshop will have three parts. Part one consists of three presentations on large scale system reforms from each of the participating countries. Part two consists of a moderated Q&A session. Part three will focus on the synthesis of enablers for large scale public health system reforms through interaction with the workshop participants, using a digital white board. Key messages • Disruptive times can create enabling conditions for large scale public health system transformation. • Designing and implementing large scale public health system reforms is complex, requiring passion, resilience, and collaborative leadership.

THE IMPORTANCE OF PUBLIC SPENDING IN BRAZIL'S ECONOMIC DEVELOPMENT (2000 TO 2023)

Public expenditure can influence economic development by increasing public investment. This study seeks to analyze the importance of public investments in education, health, infrastructure and human capital in the process of economic development. The objective of the article is to address, from a theoretical perspective, the relevance of public spending in Brazilian economic development. The research showed that an efficient allocation of public spending in different strategic, innovative areas with potential disseminators can influence and influence the country's economic development.

Five Years of National Health Policy in India: Critical Analysis of the Public Health Expenditure from 2017 to 2022 and Way Forward

This retrospective study assesses the impact of India’s National Health Policy (NHP) 2017 on public health expenditure and its implications for achieving Universal Health Coverage (UHC) and Sustainable Development Goal 3 (SDG-3). Using secondary data analysis from government sources, we observed health budget trends relative to GDP from 2017 to 2022. The study found a marginal increase in public health expenditure from 0.9% to 1.6% of GDP, which is below the NHP’s target of 2.5%. The results underscore the challenge of high out-of-pocket expenses, which remain a barrier to UHC. The COVID-19 pandemic has further highlighted the inadequacies of the current funding levels. We conclude that a substantial increase in health budget allocations is crucial for India to make significant strides toward UHC and meet SDG-3 targets. The study also calls for strategic enhancements in healthcare infrastructure and services to address the persistent gaps in healthcare delivery and financing. The findings advocate for a more aggressive approach to public health investment to ensure that quality healthcare services are accessible, affordable, and equitable for all citizens, thereby advancing India’s progress toward comprehensive health coverage.

Financial risk protection of heart disease‐affected households in Bangladesh: Insights from nationwide income and expenditure surveys

AbstractThis study assesses the financial risk protection (FRP) of heart disease‐affected households in Bangladesh by analyzing three rounds of Household Income and Expenditure Survey data (2005, 2010, and 2016). Amidst a global surge in cardiovascular diseases, particularly in low‐ and middle‐income countries, Bangladesh encounters an escalating burden of heart disease, with an over‐reliance on out‐of‐pocket (OOP) healthcare expenses. Our findings reveal a substantial increase in annual OOP spending for households affected by heart disease, from USD 307.4 in 2005 to USD 346.1 in 2010, and then surging to USD 650.5 in 2016. Concurrently, catastrophic health expenditure (CHE) and impoverishment incidences rose (17.6% to 18.2% to 29.3% and 3.2% to 2.2% to 3.3%, respectively), with a notable increase post‐2010. These expenses and CHE incidences were consistently higher than those in households with any ailment, underscoring a disparity in FRP, especially among economically disadvantaged, rural households and those headed by individuals without formal education. The study contributes to the literature by providing a first‐time analysis of FRP dynamics against heart disease in Bangladesh using comprehensive national data. It uncovers the worsening FRP status among affected households and highlights the need for targeted interventions to enhance FRP, particularly among the most vulnerable groups. Additionally, it emphasizes the importance of strategic public health investments to mitigate the financial repercussions of heart disease care, providing insights that are globally applicable to similar contexts.

Improved Methods for Vaccine Effectiveness Studies.

Evaluating the impact of public health investments in vaccination programs is crucial for ensuring their efficiency and effectiveness. Vaccine effectiveness (VE) studies, such as those using the test-negative design (TND), are commonly used to confirm the impact of vaccines and to guide future improvements. The TND, favored for its simplicity and cost efficiency, mitigates biases common in other epidemiological study designs. However, its validity can be compromised by inconsistent symptom definitions and retrospective data application. Here we summarize recent findings that highlight the need to address correlated vaccination behaviors when estimating VE, that suggest using negative control variables to reduce confounding, and that recommend accounting for prior infection history in VE studies to improve accuracy and reliability. These insights are important for refining VE estimation methods.

Vaccines and vaccination in prison settings: availability and model of service delivery in 20 European countries.

Prisons, due to various risk factors, are environments that are conducive to infectious disease transmission, with significantly higher prevalence of infectious diseases within prisons compared to the general population. This underscores the importance of preventive measures, particularly vaccination. As part of the international project "Reaching the hard-to-reach: Increasing access and vaccine uptake among the prison population in Europe" (RISE-Vac), this study aimed to map the availability and delivery framework of vaccination services in prisons across Europe and beyond. A questionnaire designed to collect data on the availability and delivery model of vaccination services in prisons was validated and uploaded in SurveyMonkey in July 2023. Then, it was submitted to potential participants, with at least one representative from each European country. Potential participants emailed an invitation letter by the RISE-Vac partners and by the European Organization of Prison and Correctional Services (EUROPRIS). Twenty European countries responded. Vaccines are available in European countries, although their availability differs by country and type of vaccine. The first dose is offered to people living in prisons (PLP), mostly within one month, COVID-19 is the most widely offered vaccine. In all countries, vaccines are actively offered by healthcare workers; in most countries, there is no evaluation of vaccination status among people who work in prison. The survey shows variance in vaccine availability for PLP and staff across countries and vaccine types. Quality healthcare in prisons is not only a matter of the right to health but also a critical public health investment: enhancing vaccine uptake consistently among PLP and staff should be prioritized.

Exploring Drivers of Healthcare Utilization among the Working and Non-Working Elderly Population: Insights from LASI

Background The elderly population of India has been growing exponentially over the past few decades, caused by a decline in fertility and an increase in life expectancy. The growth eventually has transcended the disease burden on the public healthcare system. This calls for a need to evaluate the healthcare utilization pattern of the elderly based on their socioeconomic and working condition. Methods Study used access to public and private healthcare services to measure healthcare utilization. Descriptive analysis and multivariable logistic regression were used to understand utilization patterns by working status and some selected sociodemographic parameters. All the results were reported at a 95% confidence interval. Results Using the data from the first wave of Longitudinal Ageing Study in India (LASI) with a sample of 22,680 older persons 60 years and above. The study identified that 50% of the working elderly access private services; however, 26% access public healthcare services. It was found that the working status of the elderly alone did not influence access to healthcare services, but education is also an essential indicator for utilizing healthcare services. Further, factors such as gender, marital status, religion, wealth, tobacco usage, self-rated health, ADL and IADL were significant predictors of healthcare services’ utilization for the elderly. Conclusion This study suggests that there are not many differences found among working and non-working status with healthcare utilization, although some sociodemographic indicators are associated with the utilization of healthcare services, highlighting that increasing health needs among the elderly requires strengthening the quality and appropriate public investment in health.

Social complexity of a fentanyl vaccine to prevent opioid overdose conference proceedings: Radcliffe Institute for Advanced Study conference proceedings

Despite significant public health attention and investment, hundreds of thousands of individuals have suffered fatal opioid overdose since the onset of the opioid crisis. Risk of opioid overdose has been exacerbated by the influx of fentanyl, a powerful synthetic opioid, into the drug supply. The National Institutes of Health Helping End Addiction Long-term (HEAL) Initiative is supporting the development of vaccines targeting fentanyl to protect against overdose. If successful, a vaccine would induce anti-fentanyl antibodies to sequester fentanyl (but not other opioids) in the blood, preventing fentanyl from crossing into the brain and reaching the central nervous system where it can cause overdose. Introduction of an overdose preventing strategy that relies on a vaccine to confer passive protection may be impactful. However, vaccines are poorly understood by the public and politicized. Moreover, the overdose ecosystem is complex and extends across numerous social, economic, medical, and cultural systems. As such, optimal use of a vaccine strategy to address overdose may benefit from multidisciplinary consideration of the social, ethical, and systemic factors that influence substance use and overdose that may also impact the acceptability of a fentanyl vaccine and related implementation strategies.In March 2022, Dr. Elissa Weitzman convened a two-day conference at the Harvard Radcliffe Institute for Advanced Study on the Social Complexity of a Fentanyl Vaccine to Prevent Opioid Overdose. In all, 19 professionals from diverse disciplines (medicine, psychology, history, ethics, immunology, vaccinology, communications, policy) attended the conference and led discussions that centered on population health and epidemiology, history of medicine and frameworks for understanding substance use, ethics, decision-making and attitudes, and operational issues to the question of a novel immunotherapy targeting fentanyl overdose. Participants also debated the risks and benefits of vaccine administration in response to fictional clinical case vignettes. A summary of the conference presentations and discussions follows.

Impact Of State Expenditures On The Increase In Life Expectancy In Brazil

This study analyses the impact of state public health expenditure on life expectancy in Brazil between 1990 and 2021, focusing on how investments in the health sector influence the population's longevity. The research uses a panel data model to explore the correlation between health spending and life expectancy, considering per capita income as a secondary variable. The results show a significant positive relationship between increased health spending and improvements in life expectancy across Brazilian states. However, another relevant finding indicates that health spending has become insufficient to significantly boost life expectancy, possibly due to rising healthcare costs driven by an ageing population. This ageing has generated increasing pressure for more health resources, requiring expanded expenditure in this sector. This study aims to contribute to the debate on the effectiveness of state health policies and encourages future investigations into optimising public health investments to maximise benefits for the population

Joseph William Bhore (1878-1960): The Architect Behind the Bhore Committee Legacy.

Sir Joseph William Bhore was a civil official from India. He pioneered the health survey and development committee, known as the Bhore Committee, which set the direction for India's public health facilities and investments. The chairmanship of the Health Survey and Development Committee, which the British colonial administration formed in 1943, is arguably the most well-known role Bhore has held. The committee was founded in 1943 and produced a thorough report in 1946. The committee's suggestions shaped India's health policy and planning and the course of the country's health care growth.

Toward better pandemic governance and preparedness: South Korea’s whole-of-nation approach to COVID-19

BackgroundThe profound impact of coronavirus disease (COVID-19) has led to an increased demand for sustainable pandemic governance practices. This study explored emerging hybrid governance practices that provide robust evidence on how to address the complex challenges of pandemics effectively. South Korea, which was severely affected by COVID-19, has implemented a novel governance approach using a whole-of-nation (WoN) model. This hybrid pandemic governance approach, which integrates both whole-of-government and whole-of-society approaches, has enabled synergistic and cohesive multi-sectoral coordination among all stakeholders (public authorities, private enterprises, and civil society) to address multifaceted challenges collectively and strengthen their resilience capacity. This study investigated South Korea’s WoN practices and their embedded context and identified key governance enablers facilitating this approach.MethodsThis study employed a case study design based on an extensive analysis of policy and program documents, drawing on South Korea’s publicly available data from January 1, 2020 to March 30, 2023. It assessed six system-level collaborative pandemic governance practices and key enablers, all of which were intended to fortify the country’s pandemic response.ResultsThe primary areas of the country’s WoN governance practices for COVID-19 control were (i) whole-of-government policy-making and response, (ii) COVID-19 testing system, (iii) digital surveillance of COVID-19, (iv) COVID-19 triage and treatment system, (v) domestic vaccine production, and (vi) community engagement. Key governance enablers for implementing the WoN model were establishing a legal foundation, ensuring decisive and strong governance and leadership, increasing public investment, applying a whole-of-health approach with augmented investment in public health, enhancing crisis communication, and mobilizing local leaders and civil society organizations in the national public health response.ConclusionsIn exploring innovative approaches to pandemic governance for increased efficacy, responsiveness, and impact, the WoN approach emerged as highly relevant. This example of emerging practice allows policy-makers to re-evaluate their governance strategies and initiatives to improve multi-agency partnerships across the country in their pandemic-preparedness planning.

From fangs to antidotes: A scoping review on snakebite burden, species, and antivenoms in the Eastern Mediterranean Region.

Snake bites cause considerable morbidity and mortality worldwide, yet evidence from low- and middle-income countries remains fragmented. This is particularly the case in Eastern Mediterranean Region where available data on snake bites is relatively weak. Without reliable data, it is difficult to make the case for greater visibility and investment to address the snakebite burden in this Region. A scoping review was therefore conducted to summarize evidence on snake bites in countries of the Eastern Mediterranean. The review employed manual and electronic searching methods of four databases plus Google Scholar, ultimately including 196 records from 20 countries published between 2000 and 2023. More than half originated from Iran, Morocco, and Pakistan. Many records lacked information on permanent sequalae, disability, snake species, and types and sources of antivenoms. When identified, offending snakes belonged to 30 species. Use of more than 12 types of antivenoms were described across the Region, and some were not specific to indigenous species. Despite the relatively large number of publications identified, the data were concentrated in just a few countries in the Region, and there was little or no information available for the remainder. As is the case worldwide, disability associated with snake bites was poorly characterized and quantified across the Region. There is an urgent need for concrete action at national and regional levels to enhance epidemiological surveillance, research, and the collection of clinical, disability and outcomes data to inform policy and public health investment. Greater regional cooperation and collaboration is also crucial for addressing this neglected disease throughout the Region.

Empowerment of Family Medicinal Plants (TOGA) as an Investment in Public Health in Sojomerto Village

Can be planted in narrow land, TOGA (Family Medicinal Plant) or what is often called a live pharmacy can be one of the traditional solutions to keep public health when the flu and cough attack. Not only is it planting and caring for toga plants also tends to be easy. In this dedication the activities carried out are planting together with the villagers of Sojomerto while explaining the benefits of plants in the area. This planting is also intended as a medium of awareness related to land use, therefore activities are carried out in the land adjacent to the village hall in order to make it easier for citizens to care for, maintain and use plants.

Access to Labour and “Differential Inclusion” for Young Venezuelan Migrants in Ecuador

Young migrants and refugees provide important inputs concerning production and social reproduction mechanisms (care work) that reproduce unequal but highly profitable patterns of accumulation around the world. The expansion of globalisation and neoliberalism has deepened such social dynamics, leading to a “multiplication of labour.” The diversification and heterogenization of migrant labour within neoliberal frameworks raise ethical and human rights concerns, including issues related to fair wages, working conditions, and access to social protections. After a neoliberal era in Latin America, the emergence of post‐development politics in the region led to increased efforts to address the needs of these populations. This article seeks to contribute to debates about “differential inclusion” in South–South migration and access to labour and social protection by analysing a specific case study of young Venezuelans, a recently growing phenomenon that has a great impact on the region. Ecuador is noteworthy because it hosts one of the largest populations of Venezuelan migrants and refugees and has adopted a human rights perspective in conjunction with public investments in social policy, health, and education. Despite efforts to legalize the work status of Venezuelan migrants, a more restrictive policy began to be implemented in 2019 that limited their access to formal labour and social protection. Within these complex dynamics of differential inclusion, instead of seeing these young migrants and refugees as victims, we analyse their resilience strategies of accessing social provisions while coping with informality and irregular status, as well as conditions of multiplication of labour. Using four real‐life stories as examples taken from a larger ethnographic study, we illustrate how dynamics of differential inclusion intersect with the gender, age, and legal status of young Venezuelans in Ecuador. The case studies are complemented with structural explanations from 6,000 household surveys collected between 2017 and 2020.

Spatiotemporal Characteristics and Risk Factors for All and Severity-Specific Preterm Births in Southern China, 2014-2021: Large Population-Based Study.

The worldwide incidence of preterm births is increasing, and the risks of adverse outcomes for preterm infants significantly increase with shorter gestation, resulting in a substantial socioeconomic burden. Limited epidemiological studies have been conducted in China regarding the incidence and spatiotemporal trends of preterm births. Seasonal variations in risk indicate the presence of possible modifiable factors. Gender influences the risk of preterm birth. This study aims to assess the incidence rates of preterm birth, very preterm birth, and extremely preterm birth; elucidate their spatiotemporal distribution; and investigate the risk factors associated with preterm birth. We obtained data from the Guangdong Provincial Maternal and Child Health Information System, spanning from January 1, 2014, to December 31, 2021, pertaining to neonates with gestational ages ranging from 24 weeks to 42 weeks. The primary outcome measures assessed variations in the rates of different preterm birth subtypes over the course of the study, such as by year, region, and season. Furthermore, we examined the relationship between preterm birth incidence and per capita gross domestic product (GDP), simultaneously analyzing the contributing risk factors. The analysis incorporated data from 13,256,743 live births. We identified 754,268 preterm infants and 12,502,475 full-term infants. The incidences of preterm birth, very preterm birth, and extremely preterm birth were 5.69 per 100 births, 4.46 per 1000 births, and 4.83 per 10,000 births, respectively. The overall incidence of preterm birth increased from 5.12% in 2014 to 6.38% in 2021. The incidence of extremely preterm birth increased from 4.10 per 10,000 births in 2014 to 8.09 per 10,000 births in 2021. There was a positive correlation between the incidence of preterm infants and GDP per capita. In more developed economic regions, the incidence of preterm births was higher. Furthermore, adjusted odds ratios revealed that advanced maternal age, multiple pregnancies, and male infants were associated with an increased risk of preterm birth, whereas childbirth in the autumn season was associated with a protective effect against preterm birth. The incidence of preterm birth in southern China exhibited an upward trend, closely linked to enhancements in the care capabilities for high-risk pregnant women and critically ill newborns. With the recent relaxation of China's 3-child policy, coupled with a temporary surge in advanced maternal age and multiple pregnancies, the risk of preterm birth has risen. Consequently, there is a pressing need to augment public health investments aimed at mitigating the risk factors associated with preterm birth, thereby alleviating the socioeconomic burden it imposes.

Pendampingan dan Pemeriksaan Kesehatan Masyarakat Desa Terong Tawah, Kabupaten Lombok Barat: Investasi Vital dalam Kesehatan Masyarakat

Health check-ups play an important role in maintaining and improving the health of individuals, especially in rural communities such as Terong Tawah Village. These health checks are not only to diagnose diseases, but also to prevent diseases and improve overall health. The purpose of this activity is to provide an understanding of the importance of health checks for residents in Terong Tawah Village as a Vital Investment in Public Health. The method used in the implementation of this activity is a collaboration between lecturers and students of Politeknik Medica Farma Husada Mataram with Community Health Centre (CHC) officers who can increase the effectiveness of health checks in Terong Tawah Village, Labuapi District, West Lombok Regency, West Nusa Tenggara in January 2024. Blood pressure and blood sugar checks play an important role in maintaining good health, preventing chronic diseases, and improving the overall well-being of the community. By emphasizing the importance of monitoring these vital signs, individuals can take proactive steps to achieve better health outcomes, while community-wide screening initiatives can have a positive impact on public health. Prioritizing regular check-ups for blood pressure and blood sugar is crucial to promoting a healthier society. As such, increasing public awareness of blood pressure and blood sugar levels is critical to improving overall health and well-being. Education, early detection, and proactive management are key components in the fight against hypertension, diabetes, and their associated complications.

How Primary Healthcare Sector is Organized at the Territorial Level in France? A Typology of Territorial Structuring.

Most the Organization for Economic Co-operation and Development (OECD) countries are currently facing the challenges of the health transition, the aging of their populations and the increase in chronic diseases. Effective and comprehensive primary healthcare (PHC) services are considered essential for establishing an equitable, and cost-effective healthcare system. Developing care coordination and, on a broader scale, care integration, is a guarantee of quality healthcare delivery. The development of healthcare systems at the meso-level supports this ambition and results in a process of territorial structuring of PHC. In France, the Health Territorial and Professional Communities (HTPC) constitute meso-level organizations in which healthcare professionals (HCPs) from the same territory gather. We conducted a study to determine, in a qualitative step, the key elements of the territorial structuring of PHC in France and, then, to develop, in a quantitative step, a typology of this structuring. A sequential-exploratory mixed-method study with a qualitative step using a multiple case approach and a quantitative step as a hierarchical clustering on principal components (HCPC) from a multiple correspondence analysis (MCA). A total of 7 territories were qualitatively explored. Territorial structuring appears to depend on: past collaborations at the micro-level, meso-level coordination among HCPs and multiprofessional structures, diversity of independent professionals, demographic dynamics attracting young professionals, and public health investment through local health contracts (LHCs). The typology identifies 4 clusters of mainland French territories based on their level of structuring: under or unstructured (38.6%), with potential for structuring (34.7%), in the way for structuring (25.3%) and already structured territories (1.4%). Interest in territorial structuring aligns with challenges in meso-level healthcare organization and the need for integrated care. Typologies of territorial structuring should be used to understand its impact on access, care quality, and medical resources.

Indiana's Public Health Investment Holds Insights For Other States.

Indiana has a business-friendly environment, but historical underinvestment in public health has yielded poor health outcomes. In 2023, when trust in governmental public health was strained nationwide, Indiana increased public health spending by 1,500percent. In this article, we explain how Indiana achieved this unprecedented legislative victory for public health, describing the context, approach, and lessons learned. Specifically, an Indiana University report linking economic vitality and overall health sparked the creation of a governor's commission charged with exploring ways to address Indiana's shortcomings. Working with the Indiana Department of Health, the commission developed multisectoral coalitions and business and government partnerships, and it maintained consistent and coordinated communication with policy makers. Lessons learned included the value of uncoupling public health from partisan narratives, appointing diverse commission membership with strategically selected cochairs, involving local leaders, and ensuring local decision-making control. We believe that Indiana's approach holds insights for other states interested in strengthening public health funding in the current era.

General practitioners in front of COVID-19: Italy in European comparative perspective

COVID-19 has highlighted strengths and weaknesses in healthcare systems all over the word. Despite the differences in primary care models in Europe, this study investigates the state-of-the-art of general practitioners (GPs) before the COVID-19 pandemic spread as a result of the reform process of the previous two decades. The GPs numbers over 100,000 inhabitants has been considered as a proxy of public health investment in GPs. Is the number of GPs increased or decreased in the last 20 years of reform processes in European countries? The main hypothesis is that European healthcare systems would have increased the number of GPs coherently with WHO recommendations. Comparative data on the number of GPs per 100,000 inhabitants in 21 European countries are investigated between 1995 and 2014 (the last available data). Data show that the number of family doctors over 100,000 inhabitants in European countries has increased over the last 20 years, except for Italy, where it has strongly reduced. Primary care has had a crucial role in managing the pandemic. Results of this study suggest that a country such as Italy, which has not invested in family doctors in the last two decades, would have been less equipped to manage the COVID-19 pandemic.