Health system resilience in the context of the COVID-19 pandemic : the gap between Eastern and Western Europe

Abstract

• It remains unclear which specific aspects of the health system play the most important role in the handling of the COVID-19 pandemic and whether there are regional differences among healthcare systems that explain different effects of the pandemic on countries across Europe. • This policy brief builds on the analysis of links between three institutional dimensions of health systems – financial input, infrastructure input and workforce input – and the number of excess deaths in 30 Eastern and Western European countries during the first and the second waves of the pandemic. This analysis provides three main findings. • Firstly, higher monetary input into the healthcare system, characteristic for the countries in Western Europe coming from public sources is linked to a lower number of excess deaths. Instead, higher monetary input coming from private sources, patients' out-of-pocket payments for healthcare, is linked to a higher number of deaths in Eastern Europe. Secondly, a higher input of healthcare workforce in form of general practitioners and nurses in Western Europe is linked to lower number of excess deaths. Thirdly, these health system characteristics have a stronger impact during periods where infection rates are high. • This policy brief specifies the following two policy recommendations, which hold particularly for Eastern Europe. One is that in order to strengthen healthcare system resilience to the present and future pandemics, countries should increase public and reduce private spending for healthcare services. Another recommendation is that healthcare systems should strengthen their primary care by increasing the numbers of general practitioners and by increasing the supply of nurses. In the absence of these, governments need to rely more unilaterally on costly restrictive measures in order to prevent the health system from being overrun.