Coping with Corona: The role of hospital care structures and capacity expansion in five countries

The Corona pandemic currently is the biggest challenge, health care systems around the globe are facing. The suggested paper reviews the responses of five countries to the first wave: Denmark, Germany, Israel, Spain, and Sweden. As this area is poorly researched from a comparative angle, it focusses the hospital care structures before the pandemic, as well as governance and capacity expansion during the crisis, in particular in intensive care. The aim is to learn from these responses to improve health systems’ resilience in the currently ongoing pandemic. In line with the criteria suggested by the OECD, we consider the following key characteristics of resilient health care systems: flexibility and adaptability in the use of existing resources, as well as planning for responding to surge in demand; the ability to create surge capacity; and the ability to avoid excess idle capacity. The main lessons we learnt from our case studies are as follows. First, a high level of hospital beds, in particular in intensive care (Germany), is costly and only of limited use in reaction to the pandemic. Staffing of hospitals, and in particular the availability of (highly) qualified nurses, is the crucial “bottleneck” in all countries. A functional equivalent to a permanently high bed capacity level is the quick adaptation of capacities according to need (Sweden and Israel). Indispensable for this flexibility is the availability of data. Sweden, as the only country in our sample where information on the number and location of ICU beds was available at the very beginning of the pandemic, had clear advantages for a flexible expansion and contraction. Also of high relevance for a timely reaction is a centralized governance structure during the pandemic (Sweden, Denmark, Israel). In the state-led health care systems (Denmark, Sweden), governmental ownership of hospitals also increases the speed of reaction. An alternative is a direct feedback-link between regulators and providers, as established in the Israeli case. However, it is not only important to increase capacities quickly, also the regional distribution needs to be considered. In Spain, although the country certainly has been hit most severely by the crisis, the autonomy of regional and even local governments and providers helped expanding capacities in those areas where they were most urgently needed. A blind spot in all countries we looked at, partly with devastating consequences (e.g. Spain, Sweden, and Germany) is the neglect of the situation of the frail elderly in nursing homes. In Israel this is mitigated by the fact that the institutional divide between long-term care beds and hospital beds is less pronounced. A focus on the vulnerable population in the ongoing situation is therefore indicated. Finally, it is also of high relevance for the performance of the hospital care system in how far the systems manage to shift mild cases of COVID-19 to ambulatory care, and to keep physician-patient contacts low (Sweden) or even avoid these entirely (Denmark). Policy makers therefore should make sure that doctor consultations using video technology are made available nationwide and reimbursed adequately.