Domain 4: Medicines and technology 31

§ Scarce attention to value-based payments and, more generally, a system based on ‘spending silos’ (hospital, outpatient and pharmaceutical expenditure).

Workforce § Chronic workforce shortages, particularly for regions under a financial recovery plan and lack of planning for a new healthcare workforce § Scarce attention to task-shifting between professional groups and inconsistent collaboration between professionals.

Medicines and Technologies

Service delivery

§ Low level of digitalisation: poor and fragmented diffusion of electronic health record - EHRs, scarce use of telemedicine (particularly before the pandemic), limited use of AI. § Regional differences in timely access to innovative treatments, devices and telemedicine solutions. § Lack of continuity of care: despite some regional differences, there is an overall tendency for a hospitalcentred approach. A lack of clear, homogeneous and effective approaches for primary care provision due to the still-unclear role of GPs. Scarce human resources for testing, tracing and other prophylactic measures § Need for more well-timed and homogenous data on service delivery. In this sense, the lack of regional epidemiological observatories does not help in the provision of updated data

discrepancy has led to excessive pressure on cost containment and resulted in a lack of adequate provision of hospital beds, staff and technologies. § Up to the end of 2020, €9.5 billion of additional funds have been devoted to the COVID-19 emergency. Some estimates suggest that the NHS has spent more than €12.5 billion to face this crisis. § Significant resources dedicated to increased number of healthcare workers, which has limited the effects of years of high turnover and inadequate retention of staff. § Long times to prepare calls to acquire personnel, not suitable for the management of a pandemic emergency. § Worsening of the already heavy workload of healthcare workers (especially for some clinical specialties). § During COVID-19, a strong dependence on other countries for the purchase of medical devices (masks, gloves, pulmonary ventilators). Low levels of stockpiles. § Participation in collective purchasing agreements in participation with other

EU countries for COVID-19 vaccines. § The presence of good primary assistance has allowed some regions to avoid the saturation of hospitals, thanks to early patient care. Different maturity of primary care arrangements has produced significant outcome variations.

§ The conversion of hospitals to

COVID-19 hospitals led to the suspension of elective outpatient and surgical activities in several phases of the pandemic.