27 September 2020, NIICE Commentary 6024
Dr. Vartika & Dr. R. Nivedita
COVID-19 acquiring ubiquitous characteristics in the past few months has hit every part of the world. It has sent billions of people under lockdown as major healthcare services strive to cope with the existing pandemic crisis. Further, the pandemic has burdened the healthcare systems with the need to procure essential medical kits such as the PPE, masks, sanitizers and critical medical equipment such as ventilators. Care for both healthcare workers and patients is the need of the hour. Today, the severity of the situation has been mixed depending on the implementation of the resource plan to contain the spread of the virus. In many countries some common efforts have been laid by the Union Government to contain the outbreak into community spread i.e., transiting into stage three; chief among them being lockdowns, travel bans both domestic and international. Despite these efforts some of the leading investors on health care seemed to grapple with a riposte to the pandemic. The article looks into the history of the British and the German health system systems and how they have been dealing with the pandemic in the past few months.
Healthcare in Germany and the UK: A Historical Account
The National Health Service (NHS) was founded in 1946 after the Second World war, and is responsible for the public healthcare sector of the UK. It was first proposed to the Parliament in the 1942 Beveridge Report on Social Insurance and Allied Services. It has evolved to become one of the largest healthcare systems in the world. NHS was funded on the principles of universality, free at the point of delivery, equity, and paid for by central funding by a politician named Aneurin Bevan. But before the NHS, during the he Victorian times, the hospitals were institutions founded and funded by the middle and upper classes to serve the medical welfare needs of the working-class population without charge. The rich or affluent were not allowed in the hospitals as they could have afforded a private doctor. The hospitals were places of charity and were for free. The first ‘almoner’ Miss Mary Stewart was appointed at London’s Royal Free Hospital in 1895 and this led many hospitals to follow the same system. It is very interesting to note that it was assumed that almoners, who were precisely women, should be a ‘respectable, educated, unmarried middle-class woman.’ Although, the increasing healthcare expenses after the first world war led hospitals asking for money from the patients. But interestingly, again ‘almoners’ were appointed to look into an individual’s social background and family set-up when determining the appropriate amount that they should pay. This has also led to the introduction of National Insurance, by Liberal Chancellor of the Exchequer David Lloyd George in 1911 which was subsequently amended and expanded in the 1920s and 1930s.
The German healthcare system was established in the nineteenth century whose foundation was laid in 1883 by its first chancellor, Otto von Bismarck. Since then, Germany has evolved one of the most comprehensive and extensive healthcare systems in the world and has been an example to many European and non-European nations. The earliest form of health insurance can be seen in the Middle Ages after the advent of industrialisation in Germany, wherein guilds and miners’ association became important as mining involved substantial risks and thence, a solidarity was meant to be instituted. Later, with the intensification of industrialisation, different social insurances were formalised under Bismarck. Health insurance was introduced in 1883, which provided indemnity to both workers of industrial and non-industrial sectors on account of an illness. Until reunification of Germany in 1990, Germany had two healthcare systems, in West and East Germany respectively. Following the fall of the Iron Curtain healthcare system in East Germany underwent significant reforms in order to bring it parallel to the system prevalent throughout West Germany. The German healthcare system is based on four major principles: first, gesetzliche Krankenversicherung – GKV (Compulsory Statutory Health Insurance) – This health insurance is based on the theory of solidarity. Second, premiums of healthcare are paid by the protected employee or employer. Surplus from the tax revenues collected too contribute to the insurance premiums; third, principle of solidarity – under this principle all people covered under the statutory health insurance are entitled to medical benefits and regular payment of wages irrespective of their premium and income levels as the former is based on the latter; and fourth, the principle of self-administration. At the centre, the Bundesministerium für Gesundheit (The Federal Ministry of Health) is responsible for making laws and setting forth administrative norms for various self-governing activities operating within the healthcare system. Furthermore, it is responsible for setting guidelines for a number of institutions, which deal with public health. With regard to the statutory health insurance, the Gemeinsamer Bundesausschuss (The Federal Joint Committee) is responsible for all decisions related to the self-administering healthcare systems. Furthermore, it also takes decisions pertaining to the kinds of medical facilities that will be covered by the statutory health insurance. Aside from the aforementioned basic principles of the healthcare system, Germany has been successful in accomplishing the following intent, which can be attributed to its strengths. First, the universal access to healthcare; second, its quality; third, the provision given to the patients to choose their physicians; and fourth, widely acceptable cost. While the German Healthcare System takes ample initiative to secure lives of individuals; however, it is facing potential financial challenges. For instance, financial distress increased with the unification of West and East Germany and thus, an attempt to bring a common healthcare system. Further, the rise in the aging population has led to an increase in the demand for medical care without corresponding expansion of the financial contributors. Lastly, the increase in non-wage labour costs is not competitive in domestic as well as outside areas. Also, the substantial increase in the unemployment ratio has led to mounting burden on insured employees or employers; thence, inadequate contributions to the healthcare fund.
The UK and Germany: Comparative Study of Healthcare Systems During COVID-19
Looking into the history and structure of the healthcare systems in both the countries, it can be concluded that both are different in terms of their financing, service provision and governance mechanisms. To understand it better, the National Health Service (NHS), is funded out of general taxation while the German health care system is funded through social insurance contributions. Comparing the United Kingdom with Germany as one of the top ranked countries in terms of its preparedness for the pandemic in Europe, saw a steep rise in positive cases mounting to about 80,000 by the second week of April including the Prime Minister Boris Johnson and about 10,000 deaths. At present the total number of positive cases has reached to 261,184 whereas in Germany it is estimated to be about 172,002. According to World Bank reports the total healthcare expenditure (%GDP) of the United Kingdom is 9.63 percent, while Germany invests about 11.25 percent. In fact, Germany has been eulogised to contain the spread of virus and increase in the recovery rate of people. Germany enacted upon public restrictions in the second week of March and thus, restraining the transmission. In one of her addresses, Angela Merkel announced that the lockdown could be restored in case of a spike. As Germany moved into its second phase, it eased numerous public restrictions.
Germany began testing for COVID-19 early this year and thus, keeping the death toll reasonably low. Furthermore, the state allowed the labs to produce its own testing kits and also instructed its people to assist healthcare workers and thereby reduce the number of affected cases. Also, in comparison to other European countries, Germany has more intensive care units and ventilators and has transformed a number of schools into makeshift hospitals. In the United Kingdom, the National Health Service announced that it would make available multiple hospital beds including purchasing spaces from private hospitals. It would postpone any non-emergency medical procedures to make room for COVID-19 cases. Despite these measures the country lacks essential medical kits and protective equipment.
Whilst both countries have been on their toes to contain the grip of the pandemic, they are equally seeking to develop immunity to the virus by advancing a vaccine that can combat COVID-19 vis-à-vis save humanity. Germany’s BioNtech has collaborated with Pfizer and has announced positive updates from its Preclinical and makes a headway towards Phase I/II testing together. Oxford’s AstraZeneca is the frontrunner however, it has temporarily terminated the Phase III trials of the vaccine after a human the subject of the experiment developed an unpropitious reaction.
