Decentralization, policy capacities, and varieties of first health response to the COVID-19 outbreak: evidence from three regions in Italy

Effective response to a pandemic depends not only on national dynamics and characteristics but also on the features of a country’s political and administrative decentralization and on the organizational capacities of the health system. As a result, different policy capacities can be present in the same national health system, and this variance allows us to understand local policy actions and their outcomes. Based on this assumption, this paper compares the process and the content of the initial policy response in three Italian regions (Lombardy, Veneto, and Emilia-Romagna). These three regions simultaneously experienced the most intense diffusion of infections and adopted very different strategies to mitigate the transmission of the virus. Our comparison reveals how the characteristics of Italy’s decentralized health system and the consequent differentiation in terms of health policy capacities have clearly driven very different regional first health policy responses and outcomes with regard to dealing with the spread of COVID-19.