International Conference on Economics, Finance & Business, Prague

CENTRALIZED HEALTHCARE GOVERNANCE AND ECONOMIC MANAGEMENT: COMPARATIVE INSIGHTS FROM ITALY AND FRANCE

MUHAMMAD MEHRAN LATIF, CLAUDIA ZAGARIA

Abstract:

Centralized healthcare financing systems represent a governance and economic policy model aimed at promoting equity through standardized service delivery and resource allocation. The COVID-19 pandemic exposed structural weaknesses in such systems, raising questions about their capacity to balance efficiency and equity during large-scale crises. Comparative evidence remains scarce, particularly regarding fiscal arrangements, responsiveness, and regional disparities. This study examines Italy and France as representative centralized models, focusing on financing structures that shaped efficiency, equity, and outcomes during the pandemic. A systematic literature review was conducted across PubMed and Scopus (2019–2024) following PRISMA guidelines. From 300 studies, 29 met the inclusion criteria. The analysis was guided by the Equity, Efficiency and Outcome paradigm and the WHO Health System Building Blocks framework. Empirical indicators including ICU capacity, general practitioner density, vaccination coverage, and per capita health expenditure were assessed across three regions in each country to validate findings. Results indicate that centralized systems ensured cost control and standardized protocols, with France outperforming Italy on several dimensions: lower COVID-19 mortality (165,869 vs. 188,974 deaths), higher per capita health spending ($6,923 vs. $4,832), and greater ICU capacity (5.99 vs. 2.66 per 1,000). Nevertheless, marked regional disparities persisted, particularly in Hauts-de-France and Campania. Centralization enabled rapid national coordination but was constrained by bureaucratic rigidity. The study concludes that centralized financing involves inherent tradeoffs between efficiency and equity. Policy recommendations include flexible equalization mechanisms, stronger primary care, and hybrid governance approaches combining regional autonomy with centralized oversight.

Keywords: Centralized Financing; Economic Policy; Governance; Health Systems; Regional Disparities