Resilient Health Systems: What we are learning from the COVID-19 crisis

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This article is part of a series in which OECD experts and thought leaders – from around the world and all parts of society – address the COVID-19 crisis, discussing and developing solutions now and for the future. 

To keep updated on all of the OECD's work supporting the fight against COVID-19, visit our Digital Content Hub.

OECD Tackling coronavirus (COVID‑19) Contributing to a global effort

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Across the world, the rapid growth in the number of people infected with COVID-19, the disease caused by the new coronavirus SARS-CoV-2, is overburdening health systems, causing large-scale loss of life and severe human suffering. It is posing a significant threat to the global economy, particularly affecting the most vulnerable and further stretching a social fabric challenged by high levels of inequalities.

The elderly and those with chronic conditions are particularly at risk. Across the OECD, more than 1 in 6 people are older than 65, with 60% of them living with multiple chronic conditions. Italy, one of the most affected countries, has the second largest share of those over age 80 in the OECD, after Japan. Besides the risk of contagion, elderly people living at home are exposed to risks linked to isolation. Regardless of age, many people are facing a significant impact on their mental health.

In light of this unprecedented health crisis, all 36 OECD countries have ramped up efforts to contain this tsunami of viral infections. Social distancing, measures to detect and trace new cases, as well as improved personal and environmental hygiene, are all contributing to mitigate the huge pressure on healthcare systems. Yet such measures have different levels of effectiveness, and therefore implementing them as a package is the most effective way to maximise overall impact.

Beyond containment efforts, what have health systems done thus far to manage this health crisis?  

Some countries have strengthened access to health care, highlighting the importance of high quality universal health coverage. Today, in 23 OECD countries, 20% of people forego care due to long waiting times or travel distance, and 17% because costs were too high. To offset this, specific measures have been introduced to cover diagnostic testing and regulate their prices, for example, in the United States, Germany and France.   

To boost health workforce capacity, some countries have allowed medical students in their last year of training to start working now and have made efforts to mobilise pharmacists and care assistants. As part of a broader logistical strategy to boost efforts to diagnose people, Korea implemented a widely known drive-thru testing programme. All countries have made efforts to isolate suspected and confirmed cases, including encouraging home hospitalisation as in the United States.

Innovative digital solutions are also emerging. Access to telemedicine has been made easier in France and the United States. Israel has introduced robotic devices and telemedicine use to monitor the health status of quarantined people. Korea is trialling smartphone applications to allow those in quarantine to report the evolution of their case as well as to monitor their quarantine compliance. Artificial intelligence initiatives to track the spread of the virus and predict where it may appear next have been developed in Canada.

The crisis has exposed the need for our health systems to be more resilient to crises of such gravity. While it is too early to draw conclusions, three aspects deserve consideration.

First, there is a need to strengthen disease surveillance mechanisms and health information infrastructures. Beyond early warning and response systems based on alerts and case notification, countries with standardised national electronic health records (EHRs) can extract routine data for real-time disease surveillance, clinical trials, and health system management. However, only Finland, Estonia, Israel, Denmark, Austria, Canada, Slovakia and the United Kingdom, as well as Singapore, have high technical and operational readiness to generate information from EHRs. This calls for more efforts to lift technical and data governance barriers that prevent the effective use of such data, while respecting data privacy, in line with the OECD Council Recommendation on Health Data Governance.

Second, the crisis has exposed the importance of having adaptable health systems. Lack of any sort of excess capacity can leave countries vulnerable to an unexpected demand surge. The availability of hospital beds and their occupancy rates vary greatly across OECD countries. For acute care beds, Japan has the highest number, at nearly 8 beds per 1,000 people, followed by Korea and Germany. For selected OECD countries, intensive care unit beds vary by a factor of 6. Equipping health systems with reserve capacity will require creative approaches, such as a “reserve army" of health professionals that can be quickly mobilised; storing a reserve capacity of supplies such as personal protection equipment; and maintaining care beds that could be quickly transformed into acute care beds.  

Last, there is a need for strengthened co-ordination across countries. Besides efforts to co-ordinate an international response for rapid containment, we need to be able to accelerate the development of diagnostics, treatments and vaccines. It will currently take at least 18 months to make a new vaccine available for COVID-19. Beyond the initial spike in funding to support greater R&D efforts, there is also a need to sustain such developments should the epidemic eventually subside, so that we are better prepared for future ones. Once developed, fast-track procedures for new treatments and vaccines are important to encourage approval quickly. Commitments are also necessary to ensure that these products are made available at affordable prices where needs are the highest. As OECD Secretary-General Angel Gurría put it, we need renewed “joint actions to win the war”

For more information please see: 

Oderkirk, J. (2017), “Readiness of electronic health record systems to contribute to national health information and research”, OECD Health Working Papers, No. 99, OECD Publishing, Paris

OECD (2019a), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris

OECD (2019b), Health for Everyone? Social Inequalities in Health and Health Systems, OECD Health Policy Studies, OECD Publishing, Paris

OECD (2020a), Flattening the COVID-19 peak: Containment and mitigation policies, Updated 24 March 2020, OECD, Paris

OECD (2020b), Beyond Containment: Health systems responses to COVID-19 in the OECD countries, Update 20 March, OECD, Paris

OECD, Recommendation of the Council on Health Data Governance, OECD/LEGAL/0433

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Tackling COVID-19 Health

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Francesca Colombo

Head, Health Division, Directorate for Employment, Labour and Social Affairs, OECD

Francesca Colombo oversees work on health, which aims at providing internationally comparable data on health systems and applying economic analysis to health policies, advising policy makers, stakeholders and citizens on how to respond to demands for more and better health care and make health systems more people centred. Major activities of the OECD Health Division cover trends in health spending; measuring of health care outcomes, activities and inputs; health care quality policies; assessing health system efficiency and value for money; long-term care systems and ageing; the economics of public health; pharmaceutical policies, new technologies and big data in health; and health workforce. Mrs Colombo has over 20 years of experience leading international activities on health and health systems. Over her career, she travelled extensively in Europe, South America and Asia, advising governments on health system policies and reforms. Follow me on Twitter @OECD_Social http://twitter.com/OECD_Social

1 Comments

Go to the profile of Betty-Ann Bryce
Betty-Ann Bryce about 2 months ago

Really interesting article, wondering if you are looking at health system capacity in rural communities.