Administrative Border Effects in COVID-19 Related Mortality

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