The European Health Systems Facing the Covid-19 Outbreak: A Macro-Regional Approach

Abstract

The article proposes the concept of ‘health macro-region’ as a comprehensive contextual framework for comparative analysis of European health systems beyond the conventional ‘methodological nationalism’ in comparative research based on national analyses. The impact of the Covid-19 pandemic in five European health macro-regions is then examined by an analysis of the epidemiological data to assess whether there have been significant differences in the incidence of the pandemic, assuming some structural connections with the responses given by the different health care systems. The significant inter-regional variations detected confirm the heuristic validity of the concept of ‘health macro-region’ but, at the same time, reveal equally significant intra-regional variations highlighted by the coefficients of variation.

Keywords:

• Health system
• health macro-region
• European health macro-regions
• Covid-19
• comparative health systems research

Notes

1 We will refer here to the European Union in a broader sense, including the countries considered preferential partners such as Norway, Iceland and Switzerland, as well as the United Kingdom after Brexit. We will not instead consider the Balkan countries of the former Yugoslavia and Albania, given the complex transition they are still going through; nor the ex-Soviet Republics of Ukraine, Moldova and Belarus, given their continuing link with Russia, a Eurasian country: both groups of countries would probably deserve separate treatment as further health macro-regions.

2 The idea of a “family of nations” as an analytical tool for identifying dimensions of affinity between historical cases (which can however also be grouped differently on the basis of other dimensions) was advanced by Castles (1993) in the comparative political field; Smith (1990) spoke instead of “families of area cultures” to indicate the formation of homogeneous cultural areas as potential intermediate contexts of identity construction for the social actors between national particularism and globalizing universalism.

3 The classic typology of European health care systems identifies the two Western European models of the Bismarckian one (the oldest, based on compulsory social health funds, established in Germany in 1883) and the Beveridgian (based on a national health service, established in the United Kingdom in 1948).

4 In particular, for the epidemiological dimension we will rely on the comparative analysis of our processing of five indicators (no. of cases, % cases / population, no. of deaths, % deaths/cases, % deaths/population) from WHO source (WHO Coronavirus Disease COVID-19 Dashboard, https://covid19.who.int/info) and a sixth indicator based on the relationship between diagnostic tests and population from national data and the EUROSTAT database (https://ec.europa.eu/eurostat/data/), presenting in summary the epidemiological situation of the pandemic in various European countries updated to 7th November 2020. For the structural dimension, we will instead mainly refer to the information provided by the COVID-19 Health Systems Response Monitor of the European Observatory on Health Systems and Policies (https://www.covid19healthsystem.org/mainpage.aspx).

5 Although it should be noted that the number of tests carried out does not necessarily correspond to the number of people actually tested (unless otherwise indicated), since a person could have carried out multiple swab tests.

6 C:/Users/Win10Pro/Downloads/HSRM_Uni_ 20210131%20(1).pdf: p.17 (accessed on January 31, 2021).

7 C:/Users/Win10Pro/Downloads/HSRM_Uni_ 20210131%20(1).pdf: p.23 (accessed on January 31, 2021).

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10 C:/Users/Win10Pro/Downloads/HSRM_Swe_20210131.pdf: p.2 (accessed on January 31, 2021).

11 C:/Users/Win10Pro/Downloads/HSRM_Swe_20210131%20(6).pdf: p.4 (accessed on January 31,2021)

12 In France including, beyond medical experts, even sociologists and athropologists.

13 https://www.rijksoverheid.nl/onderwerpen/coronavirus-covid19/documenten/kamerstukken/2020/09/01/kamerbrief-over-lessons-learned-covid-19 (accessed on January 31, 2021).

14 https://C:/Users/Win10Pro/Downloads/HSRM_Bul_20210130.pdf, (accessed on January 31, 2021).

15 https://C:/Users/Win10Pro/Downloads/HSRM_Ita_20210131.pdf, p. 7 (accessed on January 31, 2021).

16 https://www.mscbs.gob.es/gabinete/notasPrensa.do?id=4786, p. 7 (accessed on January 31, 2021).