Why are some countries better than others

Health Systems: Why Some Countries Cope With COVID-19 Better Than Others

The COVID-19 pandemic has kept the whole world in suspense over the past few months. But why has some countries been hit harder than others? And what do the different health systems have to do with it? A study by the Scientific Institute of Private Health Insurance (WIP) provides the first answers to these questions.

Even if the COVID-19 pandemic is far from over, the situation in Germany has eased significantly in recent weeks. And overall it can also be said: Compared to other countries, the Federal Republic has so far got off relatively lightly. But why is that? Dr. Christine Arentz and Dr. Frank Wild from WIP compared 15 European countries with one another for their study.

How are the health systems set up overall? And how well were you prepared for the crisis? "We selected 15 countries for our study that are relatively similar in terms of economic performance and culture," explains Arentz at the beginning of the press conference on the study.

Inpatient acute care: Germany has 602 beds per 100,000 inhabitants

One result of the comparison: Germany is doing particularly well when it comes to hospital and intensive care beds. There are 602 beds in inpatient acute care available for every 100,000 inhabitants in the Federal Republic of Germany - that is almost three times as many as in Sweden, Great Britain or Spain, for example. And Germany is also ahead when it comes to the number of intensive care beds with ventilation options: while 38.2 intensive care beds per 100,000 inhabitants are available here, Portugal, for example, only has 4.2.

Number of intensive care beds per 100,000 inhabitants

Another factor: What about the human resources in the health system? Here, too, Germany - along with France, Denmark and Austria - is well equipped above average. However, if you look at the workload of medical and nursing staff, the picture changes. Anyone who works in a hospital in Germany takes care of significantly more patients than their colleagues in other European countries.

Currently fewer corona tests in Germany than capacitive possible

The question of how corona tests were handled in the various countries also plays a role in the comparison. In Germany, for example, the tests began at the end of January - but only people who showed symptoms and had contact with infected people or who were in a risk area were tested. The Robert Koch Institute now recommends testing all people with symptoms - without having to meet other criteria. The situation is completely different in Luxembourg, for example: everyone has been able to get tested here since the beginning of May - regardless of whether they have symptoms or not. Germany tests fewer than other countries per 1 million inhabitants, but the test capacity is significantly higher and is currently not being fully exploited.

Differences in the living and housing situation among seniors

However, the study authors also name other factors that have shown that Germany has weathered the Corona crisis relatively well so far. The structure of households is also important: while in this country a particularly large number of seniors over 65 years of age live in single or two-person households, there are significantly more large families, especially in southern Europe, where young and old live under one roof. This could quickly become a problem during the pandemic because younger family members can easily infect the elderly, who are particularly at risk. And senior citizens who live in nursing homes could also be better protected in Germany and Austria. This patient group accounts for the majority of COVID-19-associated deaths in all countries. So far (as of: 16.6.) 39 percent of deaths in Germany have been caused by nursing home residents, in Belgium this figure is more than half at 51 percent. The situation is similar in France (49 percent) and Sweden. If you put the number of deceased nursing home residents in relation to all nursing home residents in a country, it becomes clear that in Austria and Germany the proportion of those who died of COVID-19 is 0.3 percent and 0.4 percent, respectively, well below other countries.

Proportion of COVID-19 deceased nursing home residents among all nursing home residents



Good interaction between outpatient and inpatient care

Another factor is the good interaction between outpatient and inpatient care in Germany. While in other countries the majority of patients were tested and treated in hospitals, laboratories and medical practices played a greater role in Germany. In the Federal Republic of Germany only 20 percent of the patients were treated as inpatients, in other countries such as France it was more than two thirds (67 percent). "Germany was also able to prevent overloading of the system due to the high capacities in both outpatient and inpatient areas as well as good patient management," the study says.

Proportion of hospitalized infected people in selected countries

What are the reasons why Germany has come through the Corona crisis relatively well so far? In addition to the well-equipped health system, the early tests and a social structure that presumably made the spread of the virus more difficult, the study authors also see political factors such as the fast, regional crisis management by the 400 health authorities in the country. In addition to all of these measurable criteria, Arentz added another point: "We are definitely just lucky". In Germany, for example, the situation in Italy, where the virus went unnoticed for a long time, was able to be observed and responded to.

But even if the low number of infections in Germany is currently relaxing: A look at other countries shows that the pandemic is not over yet, explained the study authors. "In our globalized world, we always have to expect the virus to come back to us," said Wild. Therefore, the result of the study can only be an intermediate result so far.