TABLE 3.
Overview of health systems prerequisites and capacities of health workforce
| Health system prerequisites | Capacities of health workforce | |||||
|---|---|---|---|---|---|---|
| Funding | Provision | Governance | Absorptive | Adaptive | Transformative | |
| Austria | ‐Social insurance funding | ‐Welfare‐mix in provision; | ‐Federalist & corporatist governance; federal government, social insurance & provinces as main players | ‐Specially chartered trains for Romanian carers to return to Austria despite closed borders | ‐Increase in carers (numbers of foreign carers; wage increases & improvement of working conditions) | ‐New service offerings in mental health (online consultations, free hotlines) |
| ‐Additional emergency funding | Weak integration across sectors, | ‐Increase of therapy sessions reimbursed by social insurance; increase in fees | ||||
| ‐Highly flexible allocation of funding | ‐High density of health workforce, but shortages in elder care & mental health; | |||||
| Predominance of medical division of labour | ||||||
| Germany | ‐Social insurance funding | ‐Welfare‐mix in provision; | ‐Federalist and decentralised governance based on corporatism | ‐Redeployment of nurses in hospitals | ‐Recruitment of new staff (more full time staff, returnees to clinical practice, retired workers, foreign trained workers) | ‐Upward mobility of public health staff/doctors (policy & organisational levels) |
| ‐Additional emergency funding, including bonuses for nurses in elder care | Weak integration across sectors | ‐Poor integration of non‐medical professional interests | ‐Cancellation of elective treatment, overtime work, holidays | ‐Establishment of auxiliary hospitals (existing staff & up‐skilled nurses) | ‐Greater collaboration between public health doctors and family physicians | |
| ‐Highly flexible allocation of funding | ‐Overall high workforce density; | |||||
| Predominance of medical division of labour | ||||||
| Netherlands | ‐Social insurance funding | ‐Publicly regulated, private provision; | ‐Governance based on corporatism & medical self‐regulation; increasing decentralisation and marketisation | ‐Increase in capacity in hospitals by partial suspension of quality standards, cancellation of overtime work, holidays | ‐Recruitment of health workers with lapsed registration | ‐New service offerings in mental health (psychological support for health workers) |
| ‐Additional emergency funding, including bonus for nurses | Some integration across sectors | ‐Poor integration of nursing interests | ‐Scaling up of ICU care with new teams | ‐Formalisation of e‐care provision (hospitals, primary care) | ||
| ‐Flexible allocation of funding | ‐High density of health workforce, but shortages in some hospital specialties & elder care | |||||
| Denmark | ‐National and local tax funding | ‐Predominance of public hospitals; | ‐Governance based on public corporatism with broad integration of public & professional interests | ‐Temporary suspension of collective agreements (work responsibilities, working times) | ‐Recruitment of new personnel for Covid‐19 wards | ‐Agreement on reimbursement of newly introduced video consultations in general practice |
| ‐Additional national emergency funding | Strong integration of elder care & municipal health/social care; weaker integration of hospitals, GPs & municipalities weaker | ‐Pandemic recognised as mitigating circumstances for clinical errors | ‐ Refocussing of nested structure of intersectoral/professional meetings at regional/municipal and hospital levels | |||
| ‐Marked shortages in elder care & rural general practice | ‐Redeployment and retraining of existing staff in hospitals & municipalities | ‐Accelerated coordination between hospitals & general practice | ||||
| England | ‐National tax funding | ‐Predominance of public hospitals | ‐Centralised health governance | ‐Redeployment of staff to free bed space and staff capacity in hospitals | ‐Increase in staffing levels (retired staff, new graduates) | ‐Formalisation of increased use of remote consultations in general practice supported by Beneficial Change Network |
| ‐Additional national emergency funding | ‐Poor integration of health & social care | ‐Danger of de‐coupling from local stakeholders | ‐New acute Covid‐19 teams | |||
| ‐Widespread and increasing shortages of hospital doctors & nurses | ||||||
| Italy | ‐National tax funding | ‐High welfare‐mix in provision | ‐Decentralised and fragmented governance | ‐Extension of working hours and flexible management of workforce (central government) | ‐Recruitment of new personnel, mostly with temporary contracts (central government) | ‐Abolishment of entry exams for doctors; introduction of Specialist Units for Continuity of Care (central government) |
| ‐Additional national emergency funding, including bonuses for health workforce | ‐Strong hospital centredness with low integration across sectors | ‐Poor integration of doctors | ‐Postponement of elective surgery and reassigned staff (local hospitals) | ‐Plans for reorganisation of health services (regions) | ||
| ‐Dominance of medical division of labour limits task shifting, strong shortage of nurses and carers, | ‐Reorganisation of service delivery (regions and local providers) | |||||
Abbreviation: COVID‐19, coronavirus disease‐2019.
Sources: Authors' own table; based on expert information; European Observatory on Health Systems and Policy's Health in Transition series [32]. Austria – [48,49,51,62,63,70]; Denmark – [28,47,54,55,56,92]; England – [52,65,74]; Germany – [27,57]; Italy – [57,59,60,61,66,72,73]; Netherlands – [45,46,64].