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. 2021 Sep;36(5):1874-1886.
doi: 10.1002/hpm.3271. Epub 2021 Jun 30.

Organisation of the State, model of health system and COVID-19 health outcomes in six European countries, during the first months of the COVID-19 epidemic in 2020

Jorge Simões  1 , João Paulo Moreira Magalhães  2 , André Biscaia  3 , António da Luz Pereira  4   5   6 , Gonçalo Figueiredo Augusto  1 , Inês Fronteira  1
Affiliations

Organisation of the State, model of health system and COVID-19 health outcomes in six European countries, during the first months of the COVID-19 epidemic in 2020

Jorge Simões et al. Int J Health Plann Manage. 2021 Sep.

Abstract

The time and type of the States' responses to the COVID-19 pandemic varied with the severity of the epidemiological situation, the perceived risk, the political organisation and the model of health system of the country. We discuss the response of Germany, Spain, France, Italy, Portugal and the United Kingdom during the first months of the COVID-19 epidemic in 2020, considering the political organisation of the country and its health system model. We analyse public health measures implemented to contain or mitigate the pandemic, as well as those related to governance, resources and reorganisation of services, financing mechanisms, response of the health system itself and health outcomes. To measure the burden of COVID-19, we use several indicators. The adoption of measures, to contain and mitigate epidemic varied in degree and time of adoption. All countries reorganised their governance structure and the provision of care, despite the differences in political models and health systems (ranging from a more unitary and centralised political organisational model-France and Portugal; to a decentralised matrix-Germany, Spain, Italy and the United Kingdom). Rather than the differences in political models and health systems, the explanation for the success in tackling the epidemic seems to lay in other social determinants of health.

Keywords: COVID-19; Europe; State; health systems; political organisation.

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Conflict of interest statement

Jorge Simões is with the Portuguese Ministry of Health. Gonçalo Figueiredo Augusto is currently advisor to the Assistant State Secretary for Health. André Biscaia is the national coordinator of the Action Plan for the Prevention of Violence in the Health Sector of the Directorate‐General of Health. António da Luz Pereira is currently a Clinical Auditor—Department for Healthcare Quality in the Directorate‐General of Health in Portugal. The other authors declare that there are no conflict of interests.

Figures

FIGURE 1
FIGURE 1
COVID‐19 14‐day infection rate per 100,000 inhabitants, in France, Germany, Italy, Portugal, Spain and the United Kingdom, between 22nd February and 31st August 2020
FIGURE 2
FIGURE 2
All‐cause age group standardised mortality rate per 100,000 inhabitants, per week, between 2nd January and 2nd May 2020
FIGURE 3
FIGURE 3
Maximum variation (%) of all‐cause mortality (10 years period or latest available) between 1st January and 30th June 2020
See this image and copyright information in PMC

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