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Health system response to Covid-19: Experience from European countries
Reinhard Busse, Prof. Dr. med. MPH
Dept. Health Care Management, Technische Universität Berlin (WHO Collaborating Centre for Health Systems Research and Management)
&European Observatory on Health Systems and Policies
Equity
Access(ibility)incl. financial protection
Quality (for those who
receive services)
Populationhealth outcomes(system-wide effectiveness)
Responsiveness
How good are health systems? A performance assessment framework I
Access(ibility)incl. financial protection
Quality (for those who
receive services)
Populationhealth
outcomes(system-wide effectiveness)
Responsiveness
Costs/ expenditure, physical inputs and/or physical outputs
System efficiency/ cost-
effectiveness(i.e. population health
and/ or responsiveness per cost/
input/ output unit)
Equity
Equity
Equity
PCosts/ expenditure
Physical outputs
Technical efficiency
OR▲population health and/
or responsiveness per
▲cost unit
How good are health systems? A performance assessment framework II
From “normal” utilization rates (seen as [in]efficiency) to health system usage in COVID times
Both a big ambulatory and hospital sector making the right decision to de facto focus on the first
Initially used almost only hospitals (80% of tests!)
Often hospital focusedbut lots of regional variation
Simplified visualisation of health care usage at the peak of the epidemic (early April) in Germany
14 : 1Test In-fected
Hospita-lised
Intensive Care3 : 1
7 / 100.000= 6.000 / day
1,4 / 100.000= 1.200 / day
0,5 / 100.000= 400 / day
1 : 0,3Died
0,3 / 100.000= 270 / day
1 : 0,045
5 : 1
40% in ICU90% in hospitals
14 : 1Test In-fected
Hospita-lised
Intensive Care3 : 1
1,4 / 100.000= 1.200 / day
0,5 / 100.000= 400 / day
1 : 0,3Died
1 : 0,045
5 : 1
40% in ICU90% in hospitals
600 / 100.000beds
in 1.350 hosp.
35 / 100.000ICU beds
in 1.150 hosp.
Only care for inambulatory care
How does this compareto Germany‘s available health care resources?
Early flowchart (late February): home care until test result, hospitalisation
for all patients with positive tests
Later flowchart: continued care at home for test-positive persons
unless hospitalisation necessary
How did this compare to other countries?
2 : 1
1 / 100.000 0,5 / 100.000
1 : 0,3Died
7 / 100.000
ES 17AT 10IT 9
(Lombardy 21)UK 8NL 7FR 7
DK 6NO 5
IT 4 : 1FR 4 : 1
ES 4,5 : 1AT 5 : 1NL 5 : 1DK 9 : 1
NO >20 : 1
ES 10 : 1IT 8 : 1DK 7 : 1UK 5 : 1FR 5 : 1NL 4 : 1
Everywhere fewer than in DE
14 : 1Test In-fected
Hospita-lisation
Intensive Care3 : 15 : 1 1 : 0,3
FR 3 : 2ES 2 : 1NL 5 : 2IT 3 : 1UK 3 : 1DK 5 : 1
CH 8 : 1AT 9 : 1
Almost everywhere fewer than in DE Often higher
than in DE Lombardy2 : 1
Emilia-Romagna
3 : 1Veneto
5 : 1
Currently hospitalised patients in relationship to total incidence (both per 100 000 population) over timeLombardy
BelgiumFrance
Emilia-Romagna
Italy
Currently ICU-treated patients in relationship to total incidence (both per 100 000 population) over timeLombardy
BelgiumFrance
Emilia-Romagna
NetherlandsICU capacity Lombardy
ICU capacity Netherlands
Outcomes: excess mortality – probably the ultimate indicator
+63%
+49%
+60% +63%+47%
+28% +24% +16%+17%
+39%
+6%
+10% +2%+5% +2%
Conclusions
• We will not need to re-invent our Health System Performance Assessment framework
• But certain interpretations and emphasis need to change, e.g. a strong primary care system might not be good if no testing exists and people still go directly to hospital
• In the crisis, keeping people out of hospitals was the key to success• Coordination and cooperation between public health services,
ambulatory care and inpatient care needs to be re-assessed