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Taking stock of OECD Health Systems in the face of Covid-19

Three questions to Francesca Colombo

INTERVIEW - 29 June 2020

Francesca Colombo, Head of the Health Division at the OECD took part in the webinar "OECD Health Systems in the face of Covid-19: How did they deal with the emergency and how do they prepare for the aftermath" organised by the Institut Montaigne on June 9. She discussed the management of the Covid-19 crisis in OECD member countries and presented some key policy responses. In a conversation with Laure Millet, Head of the Healthcare Policy Programme at Institut Montaigne, she shared her analysis on three key elements for a way out of the crisis and continued strengthening of health systems resilience: the reorganisation of care, testing policies and supply chains. The interview was originally conducted in French.

How has the link between hospitals and primary health care services been managed in OECD countries in the fight against Covid-19?

The countries with the most resilient health systems have relied and made strong use of primary health care and community services to reduce pressure on health systems, such as Nordic countries, Australia and Slovenia. Australia and Slovenia, for example, have set up Covid-19 community care facilities to avoid overcrowding in hospitals and to offer safe patient care in other primary health care centers. These facilities manage patients experiencing mild Covid-19 symptoms who require primary-care level treatment, and work in close cooperation with other primary health care centers. That said, the strength of primary health care and its role in managing varies greatly across-country.

Strong primary care is essential also to continuing to provide ongoing routine care to patients who do not have Covid-19, who risk either not seeking care or having poor access to it as their symptoms and illnesses worsen. To improve the resilience of the healthcare system, primary health care must provide continuity of care and follow-up for patients, especially those living with chronic diseases. The lock-down and fears of contamination in waiting rooms have led many patients to forego care, including those who require regular follow-up for chronic diseases, such as cancer. Strong primary health care provides continuity of care, and ongoing coordination with other health professionals, thereby helping to meet the many of the needs of populations.

In France, for example, video consultations have been scaled-up to monitor patients and mitigate the risk of contamination. Delays in diagnosis and complications that could lead to avoidable hospitalisations should also be avoided.

With more structured primary care services, combined with digital solutions for remote patient monitoring, countries could avoid a large number of hospital admissions.

Before the pandemic, there were too many preventable hospitalizations in several OECD countries. In France, for example, the rate of preventable admissions for diabetes was about 15% higher than the OECD average before the Covid-19 crisis, even though the prevalence of diabetes is lower compared to most other OECD countries. More structured primary health care, combined with digital solutions and services for remote patient monitoring, help reduce a large number of potentially preventable hospital admissions.

For health systems to be more resilient to such crises, other elements must be strengthened, too. Hospitals need a minimum number of intensive care beds and critical care capacity, and, crucially, additional human resources and equipment must be rapidly mobilized to meet the sharp increase in demand.

Before the crisis, France had a higher number of intensive care beds than Italy and Spain (but fewer than Germany and Austria) and it was possible to mobilize and reallocate a large number of additional capacity to respond to the health emergency. But having a sufficient number of beds, ventilators and resuscitation equipment without a sufficient and qualified workforce is not enough. In Italy and the United Kingdom, some hospitals found themselves with enough beds but severely understaffed. The availability, flexibility and skillset of the health workforce is therefore key. There is a need to build a sufficient "reserve" that can be quickly mobilised and deployed so as not to suffer from shortages in the event of a sudden surge in demand. In order to rapidly boost hospitals’ capacity during the pandemic, emergency agreements have been concluded across regions or even between countries in some cases, so as to distribute patients as best as possible depending on local capacities and needs. In the future, these adjustment mechanisms must be well planned in advance.

How can disparities in testing strategies between OECD countries be explained?

The Covid-19 crisis will have significant economic consequences in all countries, as they have had to implement strict lockdowns. With a few exceptions such as South Korea, most OECD countries have been caught by surprise, and have been somewhat slow to put in place effective testing, tracing and tracking systems to reduce the virus transmission and minimize the risk of strict and prolonged lockdown. Effective testing makes it possible to detect the onset of an epidemic or outbreak at the earliest possible stage and isolate infected persons, helping to reduce the impact of the outbreak.

During the first weeks of the pandemic, the capacity for testing, tracking and tracing was clearly uneven across countries, undermining the ability to break the chains of transmission and contain the pandemic.

A testing, tracking and tracing strategy is fundamental to tackling a pandemic as serious as this one. Faced with a virus that spreads very rapidly with a high number of asymptomatic cases, all persons likely to be infected with the virus, as well as their "contacts", must be tested as soon as possible and in a systematic way. Many OECD countries now recognize that they were slow to do so during the first weeks of the pandemic.

The ability of health systems to contain this wave is therefore directly related to the availability of measures to reduce transmission through continued hygiene and barrier measures, testing, tracing and tracking. 

Now, the first wave seems to be under control in a number of countries in Europe. Thanks to the measures put in place, the effective reproduction number of the virus is less than one, meaning that the number of new cases is gradually decreasing. However, the virus is still circulating, and we cannot exclude the possibility of new waves in the future. We will have to live with the virus until an effective vaccine is discovered, marketed and accessible to all. The implementation of measures to reduce transmission through continued hygiene, and testing, tracing and tracking strategies are essential for health systems to contain the pandemic in the future. The cost to the economy of not implementing these measures and having to re-impose lockdowns is not only enormous, but also far greater than the cost of testing all suspected cases and their contacts.

What are some solutions for a relocation of strategic activities in Europe and France, in order to foster innovation?

The current crisis has triggered a renewed debate about supply chains and their concentration. The production of Covid-19 related goods, such as personal protective equipment for example, is concentrated in a handful of countries. Over 86% of global exports of Covid-19-related goods come from just 20 countries. The top five global exporters, which together account for 49% of trade, are Germany, the United States, Switzerland, China and Ireland.

Concentration makes supply chains more vulnerable to unexpected shocks. The issue of diversification of supply chains for medical goods is therefore important. Relocating production is not the only solution, as it would be too costly and inefficient for every country to develop production capacity that matches crisis demand and encompasses the whole value chain. An alternative, long-term solution would be to diversify sources of supply, to define upstream agreements with companies for rapid conversion of assembly lines during crises, with possible government incentives and coordination, and to build up strategic stocks (for example for personal protective equipment). At the national level, there is a need to recognize the strategic nature of the health sector and its companies. At the international level, there is a need to explore new forms of dialogue among countries, to better collaborate and share resources according to countries' needs. This co-operation must also be built around regional and local needs to best anticipate and respond quickly to sudden increases in demand.
 

 

Copyright : Jonathan NACKSTRAND / AFP

 

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