Hostname: page-component-669899f699-vbsjw Total loading time: 0 Render date: 2025-04-26T07:53:44.822Z Has data issue: false hasContentIssue false
  • English
  • Français

Coping with COVID-19: the role of hospital care structures and capacity expansion in five countries

Published online by Cambridge University Press:  10 January 2023

Mirella Cacace Open the ORCID record for Mirella Cacace [Opens in a new window] ,
Jan Böcken ,
Kristin Edquist Open the ORCID record for Kristin Edquist [Opens in a new window] ,
Tanja Klenk ,
Mario Martinez-Jimenez Open the ORCID record for Mario Martinez-Jimenez [Opens in a new window] ,
Uwe Preusker ,
Karsten Vrangbaek Open the ORCID record for Karsten Vrangbaek [Opens in a new window]  and
Ruth Waitzberg Open the ORCID record for Ruth Waitzberg [Opens in a new window]
Mirella Cacace*
Affiliation:
Catholic University of Applied Sciences, Freiburg, Germany
Jan Böcken
Affiliation:
Bertelsmann Foundation, Gütersloh, Germany
Kristin Edquist
Affiliation:
Eastern Washington University, Cheney, WA, USA
Tanja Klenk
Affiliation:
Helmut Schmidt University, Hamburg, Germany
Mario Martinez-Jimenez
Affiliation:
Imperial College London – Business School, London, UK Lancaster University, Lancaster, UK
Uwe Preusker
Affiliation:
Health System Analysis & Health Policy Research, Vantaa, Finland
Karsten Vrangbaek
Affiliation:
University of Copenhagen, Copenhagen, Denmark
Ruth Waitzberg
Affiliation:
The Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Jerusalem, Israel TU Berlin, Berlin, Germany
*
*Corresponding author. Email: mirella.cacace@kh-freiburg.de
Get access Rights & Permissions [Opens in a new window]

Abstract

This contribution examines the responses of five health systems in the first wave of the COVID-19 pandemic: Denmark, Germany, Israel, Spain and Sweden. The aim is to understand to what extent this crisis response of these countries was resilient. The study focuses on hospital care structures, considering both existing capacity before the pandemic and the management and expansion of capacity during the crisis. Evaluation criteria include flexibility in the use of existing resources and response planning, as well as the ability to create surge capacity. Data were collected from country experts using a structured questionnaire. Main findings are that not only the total number but also the availability of hospital beds is critical to resilience, as is the ability to mobilise (highly) qualified personnel. Indispensable for rapid capacity adjustment is the availability of data. Countries with more centralised hospital care structures, more sophisticated concepts for providing specialised services and stronger integration of the inpatient and outpatient sectors have clear structural advantages. A solid digital infrastructure is also conducive. Finally, a centralised governance structure is crucial for flexibility and adaptability. In decentralised systems, robust mechanisms to coordinate across levels are important to strengthen health care system resilience in pandemic situations and beyond.

Keywords

Capacity managementCOVID-19hospital care structuresintensive careperformance
Type
Article
Information
Health Economics, Policy and Law , Volume 18 , Issue 2 , April 2023 , pp. 186 - 203
Check for updates
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Anell, A, Glenngård, AH and Merkur, S (2012) Sweden: health system review. Health Systems in Transition 14, 1–159.Google ScholarPubMed
Augurzky, B, Busse, R, Gerlach, F and Meyer, G (2020) Zwischenbilanz nach der ersten Welle der Corona-Krise 2020. Richtungspapier zu mittel und langfristigen Lehren. Barmer Institut für Gesundheitssystemforschung, Robert Bosch Stiftung und Bertelsmann Stiftung (eds). Available at https://www.bertelsmann-stiftung.de/de/publikationen/publikation/did/zwischenbilanz-nach-der-ersten-welle-der-corona-krise-2020-all.Google Scholar
Bernal-Delgado, E, García-Armesto, S, Oliva, J, Sánchez Martínez, FI, Repullo, JR, Peña-Longobardo, LM, Ridao-Lopez, M and Hernández-Quevedo, C (2018) Spain: health system review. Health Systems in Transition 20, 1–179.Google ScholarPubMed
Blank, RH, Burau, V and Kuhlmann, E (2018) Comparative Health Policy, Fifth Edition. Basingstoke: Palgrave Macmillan.Google Scholar
Böcken, J and Preusker, U (2021) Hospital response capacity. What can Germany learn from other countries and their response to the coronavirus crisis? Available at https://www.bertelsmann-stiftung.de.Google Scholar
Cacace, M (2021) Krankenhausstrukturen und Steuerung der Kapazitäten in der Corona-Pandemie. Ein Ländervergleich. Bertelsmann Stiftung (ed). Available at https://www.bertelsmann-stiftung.de/de/publikationen/publikation/did/krankenhausstrukturen-und-steuerung-der-kapazitaeten-in-der-corona-pandemie.Google Scholar
Christiansen, T and Vrangbaek, K (2018) Hospital centralization and performance in Denmark – ten years on. Health Policy 122, 321–328.Google Scholar
Destatis (2018) Grunddaten der Krankenhäuser 2017. Fachserie 12, Reihe 6.1.1. Wiesbaden: Statistisches Bundesamt.Google Scholar
eSundhet.dk (2020) Sengepladser og belægning på sygehuse. Available at https://www.esundhed.dk/Emner/Patienter-og-sygehuse/Sengepladser-og-belaegning-paa-sygehuse.Google Scholar
Greß, S and Jesberger, C (2021) SARS-CoV-2-Pandemie in Deutschland: Ökonomische Bedeutung für das deutsche Gesundheitssystem. Public Health Forum 29, 5–7.Google Scholar
Hentschker, C, Mostert, C, Klauber, J, Malzahn, J, Scheller-Kreinsen, D, Schillinger, G, Karagiannidis, C and Busse, R (2021) Stationäre und intensivmedizinische Versorgungsstrukturen von COVID-19-Patienten bis Juli 2020. Medizinische Klinik – Intensivmedizin und Notfallmedizin 116, 431–439.CrossRefGoogle ScholarPubMed
Herreros, B, Gella, P and de Asua, DR (2020) Triage during the COVID-19 epidemic in Spain: better and worse ethical arguments. Journal of Medical Ethics 46, 455–458.CrossRefGoogle ScholarPubMed
Hillgren, J (2019) Svenska Intensivvårdsregistret 2018. Available at https://www.icuregswe.org/data--resultat/arsrapporter/.Google Scholar
ISCIII [Centro Nacional de Epidemiología, Instituto de Salud Carlos III] (2020) Informes COVID-19. Available at https://www.isciii.es/QueHacemos/Servicios/VigilanciaSaludPublicaRENAVE/EnfermedadesTransmisibles/Paginas/InformesCOVID-19.aspx.Google Scholar
Karagiannidis, C, Mostert, C, Hentschker, C, Voshaar, T, Malzahn, J, Schillinger, G, Klauber, J, Janssens, U, Marx, G, Weber-Carstens, S, Kluge, S, Pfeifer, M, Grabenhenrich, L, Welte, T and Busse, R (2020) Case characteristics, resource use, and outcomes of 10 021 patients with COVID-19 admitted to 920 German hospitals: an observational study. The Lancet. Respiratory Medicine 8, 853–862.Google ScholarPubMed
Klenk, T (2016) Hospital planning in a competitive arena: sustaining or suspending market forces? In Mattei, P (ed.), Health Care Governance and Accountability. Basingstoke: Palgrave Macmillan, pp. 37–62.Google Scholar
Madsen, F, Ladelund, S and Linneberg, A (2014) High levels of bed occupancy associated with increased inpatient and thirty-day hospital mortality in Denmark. Health Affairs (Project Hope) 33, 1236–1424.Google ScholarPubMed
Mendlovic, J, Gordon, ES, Haklai, Z, Meron, J and Afek, A (2017) Geographic variation in selected hospital procedures and services in the Israeli health care system. Israel Journal of Health Policy Research 6, 1–9.Google ScholarPubMed
Michalsen, A, Neitzke, G, Dutzmann, J, Rogge, A, Seidlein, A-H, Jöbges, S, Burchardi, H, Hartog, C, Nauck, F, Salomon, F, Duttge, G, Michels, G, Knochel, K, Meier, S, Gretenkort, P and Janssens, U (2021) Überversorgung in der Intensivmedizin: erkennen, benennen, vermeiden. Positionspapier der Sektion Ethik der DIVI und der Sektion Ethik der DGIIN. Medizinische Klinik, intensivmedizin Und Notfallmedizin 116, 281–294.CrossRefGoogle ScholarPubMed
Ministerio de Sanidad (2018) Estadísticas de hospitales. Tablas nacionales. Año 2018. Madrid: Gobierno de España. Available at www.mscbs.gob.es.Google Scholar
MoH Israel (2020b) Uniform definition of disease severity in patients hospitalized with COVID-19. Circular number 294754420 from July, 12, 2020. Available at https://www.gov.il/BlobFolder/reports/mr-294754420/he/files_publications_corona_mr-294754420.pdf.Google Scholar
MoH Israel [Ministry of Health Israel] (2020a) Inpatient Institutions. Available at https://www.health.gov.il/UnitsOffice/HD/MTI/info/Pages/Inpatient_Institutions.aspx.Google Scholar
MSCBS (2019) Estadística de Centros Sanitarios de Atención Especialisada. Hospitales y Centros sin Internamiento. Año 2017. Madrid: Ministerio de Sanidad, Consumo y Bienestar Social.Google Scholar
OECD (2020) Beyond Containment: Health Systems Responses to COVID-19 in the OECD. Paris: OECD Publishing.Google Scholar
OECD (2021a) Health at a Glance: OECD Indicators. Paris: OECD Publishing.Google Scholar
OECD (2021b) OECD Health Statistics. Released on July 2nd, and updated on November 9, 2021. Paris: OECD Publishing.Google Scholar
OECD/European Observatory (2021) Sweden: Country Health Profile 2021, State of Health in the EU. Paris: OECD Publishing, Brussels: European Observatory on Health Systems and Policies.Google Scholar
Ojeda, D (2020) El mapa de la ocupación de las UCI: las camas crecen un 73% para combatir el colapso. El Confidencial. 29 March. Available at https://www.elconfidencial.com/espana/2020-03-29/coronavirus-covid-19-camas-uci-hospitales_2523031.Google Scholar
Osterloh, F (2020) Krankenhausfinanzierung in der Coronapandemie. Es bleiben Unsicherheiten. Deutsches Ärzteblatt 117, A1539–A1541.Google Scholar
Panteli, D (2020) How are countries reorganising non-COVID-19 health care service delivery? COVID-19 Health Systems Response Monitor. Available at https://analysis.covid19healthsystem.org/index.php/2020/05/06/how-are-countries-reorganising-non-covid-19-health-care-service-delivery.Google Scholar
Preusker, UK (2015) Das Deutsche Gesundheitssystem Verstehen. Strukturen und Funktionen im Wandel, 2nd Edn. Heidelberg: Medhochzwei.Google Scholar
RKI [Robert-Koch Institut] (2020) Täglicher Lagebericht des RKI zur Coronavirus-Krankheit-2019 (COVID-19) Publication date: 13 October 2020. Available at https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Situationsberichte/Okt_2020/2020-10-13-de.pdf?__blob=publicationFile.Google Scholar
Rosen, B, Waitzberg, R and Merkur S, S (2015) Israel: health system review. Health Systems in Transition 17, 1–212.Google ScholarPubMed
Rothgang, H, Cacace, M, Frisina, L, Grimmeisen, S, Schmid, A and Wendt, C (2010) The State and Healthcare: Comparing OECD Countries. Basingstoke: Palgrave Macmillan.CrossRefGoogle Scholar
Sagan, A, Webb, E, Azzopardi-Muscat, N, de la Mata, I, McKee, M and Figueras, J (2021) Health Systems Resilience During COVID-19. Lessons for Building Back Better. Geneva: World Health Organization.Google Scholar
Sáiz-Pardo, M (2020) ¿Cuál es la capacidad real de las UCI españolas frente a la pandemia? [What is the actual capacity of Spanish ICUs facing the pandemic?]. Hoy España. Available at https://www.hoy.es/sociedad/salud/capacidad-real-uci-espanola-pandemia-coronavirus-20200401213544-ntrc.html.Google Scholar
SEMICYUC [Spanish Society of Intensive Critical Medicine and Coronary Units] (2020) La SEMICYUC presenta el Plan de Contingencia para los servicios de Medicina Intensiva frente a la pandemia de COVID-19. Available at https://semicyuc.org/2020/03/la-semicyuc-presenta-el-plan-de-contingencia-para-los-servicios-de-medicina-intensiva-frente-a-la-pandemia-de-covid-19/.Google Scholar
SIR [Svenska Intensivvårdsregistret] (2020) Årsrapport 2019. Available at https://www.icuregswe.org/globalassets/arsrapporter/arsrapport_2019_final.pdf.Google Scholar
SKR [Sveriges Kommuner och Regioner] (2020) Samverkan och förnyelse. En Spaning över Omställningen i Hälso och Sjukvården under fem Månader med Corona. Stockholm 2020. Available at https://skr.se/download/18.583b3b0c17e40e3038448e83/1642426451014/7585-835-7.pdf.Google Scholar
SLMF [Svensk Lungmedicinsk Förening] (2020) Lungmedicinska enheter – Kontaktpersoner. Available at https://slmf.se/lungmedicinska-enheter-kontaktpersoner/.Google Scholar
SMC [Science Media Center Germany] (2020) Auslastung der Intensivstationen: Zahlen aus Deutschland und Europa. Update: 24 March 2020. Available at https://www.sciencemediacenter.de/alle-angebote/fact-sheet/details/news/auslastung-der-intensivstationen-zahlen-aus-deutschland-und-europa/.Google Scholar
Sundhedsstyrelsen (2020) Håndtering af COVID-19: Prognose og kapacitet i Danmark for intensiv terapi. 22-03-2020. Available at https://www.sst.dk/-/media/Udgivelser/2020/Corona/Status-og-strategi/ITA-COVID-19.ashx?la=da&hash=F911DA320A32A8EF1728D6197F2FDF75024ACD4E.Google Scholar
Thomas, S, Sagan, A, Larkin, J, Cylus, J, Figueras, J, Karanikolos, M and European Observatory on Health Systems and Policies (2020) Strengthening Health Systems Resilience: Key Concepts and Strategies. Health Systems and Policy Analysis, Policy Brief 36. Copenhagen: World Health Organization. Regional Office for Europe.Google Scholar
Toth, F (2021) Comparative Health Systems: A New Framework. Cambridge: Cambridge University Press.Google Scholar
Urra, S (2020) Spain enlists medical students to shore up overburdened healthcare system. El País. 19 March. Available at https://english.elpais.com/society/2020-03-19/spain-enlists-medical-students-to-shore-up-overburdened-healthcare-system.html.Google Scholar
Vården i siffror (2020) Sjukhus. Publication date: 23 June 2020 Available at https://vardenisiffror.se/.Google Scholar
Waitzberg, R (2022) Israel country snapshot: the role of public health agencies and services in the response to COVID-19. Available at https://eurohealthobservatory.who.int.Google Scholar
Webb, E, Hernandez-Quevedo, C, Williams, G, Scarpetti, G, Reed, S and Panteli, D (2022) Providing health services effectively during the first wave of COVID-19: a cross-country comparison on planning services, managing cases, and maintaining essential services. Health Policy 126, 382–390.CrossRefGoogle ScholarPubMed
Zich, K, Nolting, H-D and Schwenk, U (2019) Faktencheck gesundheit. In Pundt, J and Cacace, M (eds), Diversität und Gesundheitliche Chancengleichheit. Bremen: Apollon University Press, pp. 291–320.Google Scholar