The contribution of the private healthcare sector during the COVID-19 pandemic: the experience of the Lombardy Region in Northern Italy
Keywords:
Private sector; Lombardy; COVID-19; pandemicAbstract
Introduction. In Lombardy, the first European region hit by the COVID-19 pandemic, for decades the regional public healthcare service has followed a mixed delivery model with extensive involvement of private accredited providers. The study aimed at examining the role of the private sector in delivering healthcare services (diagnosis, hospitalization, and vaccination) during the pandemic.
Study design. Healthcare system study
Methods. We analysed regional healthcare data referring to the period from March 2020 onwards to assess the availability of acute care and intensive care hospital beds, SARS-CoV-2 tests, and COVID-19 vaccinations. We specifically examined healthcare offered by private accredited providers within the region.
Results. Of the 12,306 converted beds for COVID-19 treatment, 4,975 (40%) were in accredited private hospitals. Intensive care beds increased by 95%, reaching 1,755, with 484 (28%) in accredited private hospitals. Since the pandemic onset, 28.9 million (62%) of SARS-CoV-2 tests were conducted by private accredited facilities including pharmacies. Private sector actively contributed to the COVID-19 vaccination campaign administering over 2.6 million doses in 2021, enhancing vaccination capacity to its peak.
Conclusions. The longstanding relationship between the public and private sectors within the Lombardy regional healthcare service facilitated a rapid increase in hospital bed capacity, the upscaling of SARS-CoV-2 testing capacity, and the achievement of vaccination goals to address the COVID-19 emergency. Therefore, alongside a robust and adequately funded public healthcare service, the private sector serves as an asset to enhance the resilience of healthcare systems, in line with WHO indications.
References
1. WHO Advisory Group on the Governance of the Private Sector for Universal Health Coverage. Engaging the private health service delivery sector through governance in mixed health systems: strategy report of the WHO Advisory Group on the Governance of the Private Sector for Universal Health Coverage. Available online from: https://www.who.int/ publications-detail-redirect/9789240018327 [Last accessed: 2023 December 11].
2. Signorelli C, Odone A, Oradini-Alacreu A, Pelissero G. Universal Health Coverage in Italy: lights and shades of the Italian National Health Service which celebrated its 40th anniversary. Health Policy. 2020 Jan;124(1):69-74. doi: 10.1016/j.healthpol.2019.11.002. Epub 2019 Nov 12. PMID: 31812325.
3. de Belvis AG, Meregaglia M, Morsella A, Adduci A, Perilli A, Cascini F, et al. Italy: Health system review. Health Syst Transit. 2022 Dec; 24(4): 1-236. PMID: 36951263.
4. Signorelli C, Fara GM, Odone A, Zangrandi A. The reform of the Italian Constitution and its possible impact on public health and the National health service. Health Policy. 2017; 121(1): 90-91. doi: 10.1016/j.healthpol.2016.10.008. Epub 2016 Oct 26. PMID: 27913055.
5. Maresso A, Waitzberg R, Tille F, Litvinova Y, Pastorino G, Nathan N, at al. Engaging the private sector in delivering health care and goods: governance lessons from the COVID19 pandemic. European Observatory on Health Systems and Policies. 2023 Nov. Report No.: Policy Brief 56.
6. European Observatory on Health Systems and Policies. COVID-19 Health System Response Monitor (HSRM).
Available from: https://eurohealthobservatory.who.int/monitors/hsrm/overview [Last accessed: 2023 November 30].
7. Bell JA, Nuzzo JB. Global Health Security Index: Advancing Collective Action and Accountability Amid Global Crisis. 2021. Available from: www.GHSIndex.org [Last accessed:
2023 December 14]
8. Odone A, Delmonte D, Scognamiglio T, Signorelli C. COVID-19 deaths in Lombardy, Italy: data in context. Lancet Public Health. 2020 Jun 1;5(6):e310. Epub 2020 Apr 25. doi: 10.1016/S2468-2667(20)30099-2. PMID: 32339478; PMCID: PMC7182509.
9. Signorelli C, Odone A, Gianfredi V, Bossi E, Bucci D, Oradini-Alacreu A, et al. COVID-19 mortality rate in nine high-income metropolitan regions. Acta Biomed. 2020 Jul 20;91(9-S):7-18. doi: 10.23750/abm.v91i9-S.10134. PMID: 32701911.
10. Mauer N, Chiecca G, Carioli G, Gianfredi V, Iacoviello L, Bertagnolio S, et al. The First 110,593 COVID-19 Patients Hospitalised in Lombardy: A Regionwide Analysis of Case Characteristics, Risk Factors and Clinical Outcomes. Int J Public Health. 2022 May 11; 67:1604427. doi: 10.3389/ijph.2022.1604427. PMID: 35645700; PMCID: PMC9131487.
11. Gianfredi V, Pennisi F, Lume A, Ricciardi GE, Minerva M, Riccò M, et al. Challenges and Opportunities of Mass Vaccination Centers in COVID-19 Times: A Rapid Review of Literature. Vaccines (Basel). 2021 Jun 1;9(6):574. doi: 10.3390/vaccines9060574. PMID: 34205891; PMCID: PMC8230199.
12. Signorelli C, Odone A, Gianfredi V, Capraro M, Kacerik E, Chiecca G, et al. Application of the “immunization islands” model to improve quality, efficiency and safety of a COVID19 mass vaccination site. Ann Ig. 2021 Sep-Oct;33(5): 499512. doi: 10.7416/ai.2021.2456. Epub 2021 Jun 11. PMID: 34113956.
13. Signorelli C, Priori M, Odone A, Vezzosi L, Colucci ME, Affanni P, et al. [New challenges in vaccination policies: the role of General Practitioners]. Acta Biomed. 2020 Apr 10;91(3-S):135-140. Italian. doi: 10.23750/abm.v91i3S.9452. PMID: 32275278.
14. Grasselli G, Pesenti A, Cecconi M. Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy: Early Experience and Forecast During an Emergency Response. JAMA. 2020 Apr 28;323(16):1545-6. doi: 10.1001/jama.2020.4031. PMID: 32167538.
15. Stirparo G, Oradini-Alacreu A, Migliori M, Villa GF, Botteri M, Fagoni N, et al. Public health impact of the COVID-19 pandemic on the emergency healthcare system. J Public Health (Oxf). 2021 Jun 22: fdab212. doi: 10.1093/pubmed/ fdab212. Epub ahead of print. PMID: 34156071; PMCID: PMC8344573.
16. Signorelli C, Pennisi F, Lunetti C, Blandi L, Pelissero G, and the working group Fondazione Sanità Futura. Quality of hospitals care and clinical outcomes: a comparison between the Lombardy region and the Italian national data. Ann Ig. 2024 Jan 23. doi: 10.7416/ai.2024.2597. Epub ahead of print. PMID: 38265640.
17. European Community Pharmacists. Position Paper on the Role of Community Pharmacists in Vaccination (PGEU). Available from https://www.pgeu.eu/publications/pgeuposition-paper-on-the-role-of-community-pharmacists-invaccination/ [Last accessed: 2024 Jan 17].
18. Decree Law 24 March 2022, n. 24. Testo del decreto-legge 24 marzo 2022, n. 24 (in Gazzetta Ufficiale - Serie generale - n. 70 del 24 marzo 2022), coordinato con la legge di conversione 19 maggio 2022, n. 52 (in questa stessa Gazzetta Ufficiale, alla pag. 1), recante: «Disposizioni urgenti per il superamento delle misure di contrasto alla diffusione dell’epidemia da COVID-19, in conseguenza della cessazione dello stato di emergenza, e altre disposizioni in materia sanitaria». Available from https://www.gazzettaufficiale.it/eli/ id/2022/05/23/22A03196/sg [Last accessed: 2024 Jan 17].
19. Ermeneia, AIOP. Health & Hospitals in Italy: 19ht Annual report 2021. Franco Angeli. 2022. Available from: https:// www.francoangeli.it/Libro/Health&Hospitals-in-Italy-19ht-Annual-report-2021?Id=27991 [Last accessed: 2023 December 14].
20. Waitzberg R, Quentin W, Busse R, Greenberg D. Dual Agency: A Fresh Perspective to Identify Dilemma Mitigation Strategies - A Response to the Recent Commentaries. Int J Health Policy Manag. 2023;12:7758. doi: 10.34172/ ijhpm.2022.7758. Epub 2022 Nov 20. PMID: 37579482; PMCID: PMC10125091.
21. van Ginneken E, Webb E, Maresso A, Cylus J; HSRM network. Lessons learned from the COVID-19 pandemic. Health Policy. 2022 May;126(5):348-354. doi: 10.1016/j. healthpol.2022.04.004. Epub 2022 Apr 9. PMID: 35568674; PMCID: PMC8993495.
22. World Heath Organization (WHO).Universal health coverage (UHC). Available from https://www.who.int/newsroom/fact-sheets/detail/universal-health-coverage-(uhc) [Last accessed: 2024 Jan 17].
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Copyright (c) 2025 Carlo Signorelli, Emanuele De Ponti, Marco Mastrangelo, Flavia Pennisi, Danilo Cereda, Fiorenzo Corti, Dario Beretta, Gabriele Pelissero (Author)
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