Suchergebnisse

Background: During the second half of the 20th century there was a positive relationship between single parenthood and the mother's educational level in Spain and Italy. Objective: However, several important transformations contemplated by Goode (1993) and McLanahan (2004) suggest that this relationship may have been inverted in Spain but perhaps not in Italy. The purpose of our study is to test this hypothesis. Methods: We use EU_SILC data from waves 2005 and 2011 and logistic regressions. Results: We found the relationship between the mother's educational level and being a single mother is negative in Spain, while it is not significant in Italy. However, we found that for Italian mothers aged 40 and younger and mothers from northwest Italy, this relationship is also negative. By contrast, for older mothers and mothers from the islands or southern Italy, this association is positive. Meanwhile, for mothers from the central and northeast regions, the relationship between educational level and single motherhood is not significant. Conclusions: These results show how Spain and some parts of Italian society are moving towards family models similar to those in the Northern European countries. As Sara McLanahan (2004) noted for the United States, this social transformation in Southern Europe cannot be considered without recognizing the potential negative consequence for future generations. The single-mother households dealing with the economic crisis that started in 2008 have lower socioeconomic backgrounds than the single mothers who suffered through previous crises, and therefore the consequences of this crisis for children in single-parent families might be even more negative, especially in Spain.

Abstract
We compare the intergovernmental health system responses to the first wave of the COVID-19 pandemic in Italy and Spain, two countries where healthcare is managed at the regional level and the impact of the first wave was highly localized. However, whereas in Italy the regional government allowed for a passively accepted central level of coordination without restricting autonomy ("descentralised coordinantion"), in Spain, the healthcare system was de facto centralized under a "single command" ("hierarchical centralization"). We argue that the latter strategy crowded out incentives for information sharing, experimentation and regional participation in decision-making. This article documents evidence of important differences in health outcomes (infected cases and deaths) and outputs (regular and emergency hospital admissions) between the two countries, both at the national and regional levels. We then discuss several potential mechanisms to account for these differences. We find that given the strong localized impact of the pandemic, allowing more autonomy in Italy (compared to centralized governance in Spain) can explain some cross-country differences in outcomes and outputs.

We compare health system responses to the first wave of COVID-19 pandemic in Italy and Spain. In both countries, healthcare is managed at the regional level, but the central government behaved differently in the uncertainty surrounding the first wave, leaving more autonomy to regional governments in Italy than in Spain. Upon documenting national and regional health system responses, we show evidence of a significant gap in the number of infected cases, alongside regular and emergency hospital admissions, and mortality in the two countries, both at the national and at the regional level. We then discuss several potential mechanisms, such as policy stringency, the localization of the pandemic and mobility restrictions, measurement error, and especially the regional autonomy, enjoyed by Italian regions but not by Spanish regional governments amidst a state of alarm in both countries. We find that, given the strong localized effect of the pandemic, allowing more autonomy, and fostering experimentation and local solutions explains the gap between Italy and Spain in the first wave of the pandemic.

Does the organisation of healthcare systems affect health outcomes in a pandemic situation? To answer this question, we analysed the effects of the Covid-19 pandemic by focusing on mortality rate outcomes and exploited the heterogeneity of the healthcare organisational models among Italian regions, which makes Italy an ideal "laboratory". Within a common national healthcare system, Italian regions are allowed large autonomy to organise themselves as mixed-markets based on choice and competition, network or centralised leadership models, each delivering different responses to the Covid-19 emergency. Exploiting the discontinuity of healthcare organisational models across the Italian regional borders around Lombardy — the region that most convincingly embraced the mixed-market model fostering competition among health service providers — we applied a difference in geographic regression discontinuity design (DiD-GRDD) to compare mortality rates in 2020 of Lombardy's municipalities with that of neighbouring municipalities in other regions and also exploited the pre-crisis period (2017-2019). Our analysis shows that mortality rates in Lombardy during the first wave were higher by 1-2 percentage points among the population of residents aged 80 years or more, compared to the past, as opposed to regions adopting different organisational models. The mortality rate differential disappeared during the second wave following the implementation of a national policy based on risk zones, limiting mobility and taking stock of the experience developed during the first wave. Finally, by investigating the channels causing higher mortality during the first wave, we show that the role of organisational model differences vanishes, as differential mortality is mostly explained by the decision of the Lombardy regional government to use care homes for hosting Covid-19 patients and reduce the excess demand on the hospital system.