The scalar arrangements of three European public health systems facing the COVID-19 pandemic: Comparing France, Germany, and Italy

Abstract

and Italy, the management of the COVID-19 pandemic has required coordination on different territorial levels of a plurality of actors-some para-public, others non-profit, and others for-profit and private-and dealing with local differences in the impacts of the crisis, all of this under severe time constraints. The healthcare systems of the three countries represent complex institutional arrangements that have undergone far-reaching reforms, mostly involving economic liberalization, in the last four decades. In particular the funding and resources available for healthcare have been subjected to radical transformations and sometimes drastic cutbacks. In keeping with the general trend in social policy that has led to marketization and increasing emphasis on individual responsibility, this shift has influenced the coordination of a wide range of players active in diverse social and territorial spaces during the COVID-19 pandemic. In this article, we examine the social coordination of the French, German, and Italian healthcare systems facing the COVID-19 pandemic by focusing on two sets of issues. First, we analyze policy discourses and crisis management measures taken by these governments. Specifically, we examine the concept of solidarity expressed by government leaders when the initial lockdowns were put in place and legal measures and governance structures drawn on in managing the crisis. Second, we look at two key operational elements in the fight against the pandemic: introduction of test strategies and provision of intensive care beds. Both require the deployment of a specific concept of solidarity-or a deceptive version of the conceptas well as coordination of key actors. The results of our comparison lead to conclusions regarding more general changes in European welfare states.

A Health Issue in Urban Politics After the Pandemic COVID-19 Outbreak

“…Giraud et al [41] also highlighted the role of health resources and activities in three European countries: France, Germany and the UK. The general trends in the social policy of the three countries in relation to health tend towards marketization and increasing the role of individual responsibility for his/her own health.…”

Hospital Capacity Reporting in Germany During Covid-19

“…Hospitals received €560 in financial aid for every empty hospital bed, calculated as the difference between current patients and the average daily number of patients treated throughout 2019 (GKV-Spitzenverband, 2021). Further, each new ICU bed a hospital created was rewarded with additional financial lump-sum compensation (Giraud et al, 2021).…”

“…In particular, in the early days of the pandemic, there were multiple examples of regional hospital systems struggling to cope with the number of patients needing ventilation and other forms of intensive care, for example in Wuhan (China) (Time, 2020;Woo & Deng, 2020), Bergamo (Italy) (Orlandi, 2020) and Brazil (Phillips, 2020). Following these early experiences, policymakers in many countries implemented schemes to increase ICU capacity and to allow hospital beds to be reserved in anticipation of a surge in patients (Giraud et al, 2021).…”

“…Many countries implemented schemes to compensate hospitals for their lost revenue and measures to support the health care system in general. For example, the UK replaced a DRG-based system with global budgets; Germany, France, Belgium, Finland and the Netherlands compensated Covid-19 related loss of revenue directly or provided extra budgets (European Observatory on Health Systems and Policies, 2021; Giraud et al, 2021;Quentin et al, 2020).…”

Assessing Urban Policies in a COVID-19 World

“…Giraud et al [57] highlighted the roles of health resources and activities in three European countries: France, Germany and Italy. The general trend with respect to the social policies of the three countries in relation to health moved toward marketization and increasing the role of individuals' responsibility for their own health.…”