TY - JOUR
T1 - Tackling the COVID-19 pandemic
T2 - Initial responses in 2020 in selected social health insurance countries in Europe☆
AU - Schmidt, Andrea E
AU - Merkur, Sherry
AU - Haindl, Anita
AU - Gerkens, Sophie
AU - Gandré, Coralie
AU - Or, Zeynep
AU - Groenewegen, Peter
AU - Kroneman, Madelon
AU - de Jong, Judith
AU - Albreht, Tit
AU - Vracko, Pia
AU - Mantwill, Sarah
AU - Hernández-Quevedo, Cristina
AU - Quentin, Wilm
AU - Webb, Erin
AU - Winkelmann, Juliane
N1 - Copyright © 2021 Elsevier B.V. All rights reserved.
PY - 2022/5
Y1 - 2022/5
N2 - Countries with social health insurance (SHI) systems display some common defining characteristics - pluralism of actors and strong medical associations - that, in dealing with crisis times, may allow for common learnings. This paper analyses health system responses during the COVID-19 pandemic in eight countries representative of SHI systems in Europe (Austria, Belgium, France, Germany, Luxembourg, the Netherlands, Slovenia and Switzerland). Data collection and analysis builds on the methodology and content in the COVID-19 Health System Response Monitor (HSRM) up to November 2020. We find that SHI funds were, in general, neither foreseen as major stakeholders in crisis management, nor were they represented in crisis management teams. Further, responsibilities in some countries shifted from SHI funds to federal governments. The overall organisation and governance of SHI systems shaped how countries responded to the challenges of the pandemic. For instance, coordinated ambulatory care often helped avoid overburdening hospitals. Decentralisation among local authorities may however represent challenges with the coordination of policies, i.e. coordination costs. At the same time, bottom-up self-organisation of ambulatory care providers is supported by decentralised structures. Providers also increasingly used teleconsultations, which may remain part of standard practice. It is recommended to involve SHI funds actively in crisis management and in preparing for future crisis to increase health system resilience.
AB - Countries with social health insurance (SHI) systems display some common defining characteristics - pluralism of actors and strong medical associations - that, in dealing with crisis times, may allow for common learnings. This paper analyses health system responses during the COVID-19 pandemic in eight countries representative of SHI systems in Europe (Austria, Belgium, France, Germany, Luxembourg, the Netherlands, Slovenia and Switzerland). Data collection and analysis builds on the methodology and content in the COVID-19 Health System Response Monitor (HSRM) up to November 2020. We find that SHI funds were, in general, neither foreseen as major stakeholders in crisis management, nor were they represented in crisis management teams. Further, responsibilities in some countries shifted from SHI funds to federal governments. The overall organisation and governance of SHI systems shaped how countries responded to the challenges of the pandemic. For instance, coordinated ambulatory care often helped avoid overburdening hospitals. Decentralisation among local authorities may however represent challenges with the coordination of policies, i.e. coordination costs. At the same time, bottom-up self-organisation of ambulatory care providers is supported by decentralised structures. Providers also increasingly used teleconsultations, which may remain part of standard practice. It is recommended to involve SHI funds actively in crisis management and in preparing for future crisis to increase health system resilience.
KW - Health policy
KW - Social health insurance
KW - COVID-19
KW - Governance
KW - Decentralisation
U2 - 10.1016/j.healthpol.2021.09.011
DO - 10.1016/j.healthpol.2021.09.011
M3 - Article
C2 - 34627633
SN - 0168-8510
VL - 126
SP - 476
EP - 484
JO - Health Policy
JF - Health Policy
IS - 5
ER -