Healthcare Network Inequality and Resilience Gaps: Evidence from Italy

This paper investigates spatial disparities in healthcare network infrastructure across Italian provinces from 2010 to 2021 and examines how these imbalances affect the resilience of the healthcare system to shocks such as the COVID-19 pandemic. Using data on hospital beds by type of care (acute, rehabilitation, and long-term) and applying inequality measures from the Generalized Entropy class, we assess both the level and evolution of territorial disparities. The decomposability of these indices allows us to distinguish inequality arising between provinces from inequality within provinces, providing insights about how hospital capacity is spatially configured across the national territory. As the Italian hospital network is organised along a regulated hub-and-spoke logic, the predominance of the within-province component of this spatial configuration should be read jointly with the regulatory framework. Our findings reveal persistent and substantial inequality, with the within-province component accounting for more than half of total inequality in most years, and disparities intensifying after 2016 and during the pandemic. By capturing the concentration of hospital capacity and its evolution over time, entropy-based measures offer a useful monitoring tool to identify structural vulnerabilities in the healthcare network infrastructure that weaken system-wide adaptability and responsiveness. The results show that resilience in Italy is undermined not only by the well-known North-South divide but also by uneven capacity within provinces, highlighting the need for policies that strengthen hospital networks at multiple territorial levels.