Over the years I have experienced four different healthcare systems in the European Union. Having grown up with the German system, I could not judge its quality until I moved abroad and experienced healthcare in Britain, Ireland and France. These different systems often form part of a country’s national identity. In Germany the system dates back to 1883 and in many EU countries it has been operating since the post-war period. So it is engrained in the way our societies operate today, which explains the varied responses to the COVID-19 pandemic.
Despite the differences in healthcare among the EU countries, there has been one general trend: towards reduced investment. Hospitals are now often treated as for-profit organizations and this has a consequence. Germany was probably just at the beginning of this development when the pandemic struck. Germans can count themselves lucky that their country had adequate reserves of hospital beds, medical and testing equipment, and staff to cope with the crisis.
But even Germany is not spared cost-cutting. As the number of new infections declined, hospitals experienced a financial squeeze due to lost revenue from unused beds and postponed non-emergency treatments during the crisis. I hope that the pandemic will trigger a rethink about healthcare and stop the march towards cost-cutting.
Many have postulated that Germany’s ‘success’ in containing the infection is the result of so many people being tested at an early stage. This shows that patients were and remained proactive in going to doctors, and that adequate testing and treatment was available. However, I would argue that this proactive response is no different from the way Germans generally react to any illness – it is part of their national healthcare identity.
Each person living in Germany is legally required to be medically insured. Since most people pay out of their own pockets for medical care, they expect value for money. Consequently, people consult doctors at short notice and have relatively high expectations of the advice and treatment they receive.
By contrast, while I lived in Britain I saw that the care provided by the National Health Service was seen more as a function than a service. As the NHS is viewed as a great iconic British institution, imperfections such as long waiting times for medical appointments are quietly tolerated. Yet such delays in treatment come at a cost and prevent individuals from taking ownership of their health.
The underfunded NHS was already struggling to cope before this pandemic. In the fight against COVID-19, the British government appealed to people to ‘protect the NHS’ – to be even less proactive in seeing doctors. If I think about the temporary erected NHS hospitals, I wonder how many additional people abstained from going to the NHS in the early infection stages, fearing they might end up in an austere, anonymous environment redolent of wartime. I already know of some who supposed they were infected, but never consulted a doctor to get tested.
My conclusion is that a country’s ability to deal with a pandemic depends on the wider healthcare environment: the availability of affordable high-quality treatment, a proactive attitude to healthcare, and the appeal and security of the treatment environment. So while a tax-financed public healthcare system such the NHS is a vital civil right, I clearly see the benefits of personal contributions as a way to maintain the highest standards.
Samantha Gordine is a member of the Common Futures Conversations community.
For more interesting perspectives, explore the Living with coronavirus full collection.