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This story is part of a reporting fellowship sponsored by the Association of Health Care Journalists and supported by The Commonwealth Fund.
In early 2020, the world witnessed a frightening new virus emerge in Italy, bringing the country to its knees. The haunting images of deserted streets, healthcare workers in full protective gear, and piles of body bags served as a stark warning to the rest of the world.
As COVID-19 swept through the United States, the lessons learned from Italy became painfully clear, prompting states like Texas to quickly implement lockdowns, ramp up testing and surveillance, and provide healthcare providers with the necessary resources.
However, neither country had the time to build a resilient healthcare system capable of adequately responding to such a crisis. Both Italy and the U.S. had long prioritized funding for flashy hospitals and high-end specialty care, neglecting primary care services. This policy choice came back to haunt them during the pandemic.
Italy has since recognized this critical issue and is redirecting a substantial portion of COVID-19 relief funds, amounting to $17 billion from the European Union, into its healthcare system, with a focus on bolstering primary care. This significant influx of funds aims to shift Italy’s healthcare system away from hospitals and toward patient-centered care.
A similar transformation is crucial in the U.S., particularly in Texas. Despite the state’s renowned hospitals and cutting-edge healthcare initiatives, Texas lags behind in primary care providers per capita. Less than 6% of healthcare spending in Texas goes to primary care, below the national average, highlighting the urgent need for change.
“COVID almost destroyed primary care in Texas,” noted Sue Bornstein, co-director of the Texas Primary Care Consortium. “It exposed the fragility of our healthcare system and the urgent need for reform.”
After years of neglect, the growing crisis in primary care in Texas has prompted stakeholders to rethink and revamp the foundation of the medical system.
The story of Italy’s response to the pandemic offers valuable lessons for Texas. Can Texas learn from Italy’s post-crisis efforts to reshape its healthcare system?
Re-centering primary care
On the surface, the American healthcare system appears vastly different from Italy’s national health system. Despite spending less per capita on healthcare, Italy delivers comprehensive care to its residents, resulting in longer and healthier lives.
In comparison, the privatized U.S. healthcare system is the costliest globally, with declining life expectancy and poor access and outcomes.
Despite these contrasts, both countries share a common challenge of prioritizing expensive acute care over accessible primary care, leading to a fragmented and inefficient system.
Primary care is recognized as the most effective and affordable method to promote community health, as emphasized by extensive research. By ensuring individuals have ongoing relationships with primary care providers, early identification of health issues, proactive management, and reduced hospital visits can be achieved.
The pandemic exposed the systemic deviation from the primary care model, particularly evident in Italy’s Lombardy region. While Lombardy boasts cutting-edge specialty hospitals, the lack of a primary care system left hospitals overwhelmed and people without essential care.
As Texas mirrors Italy’s primary care challenges, the need for a comprehensive restructuring of the healthcare system becomes imperative for both preventive and responsive care.
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