Governing the public-private-partnerships of the future: learnings from the experiences in pandemic times. (Special Issue: COVID-19 health system governance.)

When observing countries' responses to COVID-19, conclusions can be drawn on the modalities, successes, failures and governance challenges of partnerships between the public and private sectors during the pandemic. In the United Kingdom, Israel and Austria, these partnerships have contributed substantially to the overall emergency response, albeit with gaps and weaknesses in their structures and processes. These have differed from those of typical public-private partnerships. To be sustainable, partnerships need to be based on key principles of good governance, notably transparency and fairness as well as equity and social justice, all of which may be strengthened both during and post-pandemic.

What can we learn from the effects of the COVID-19 pandemic on hospital care for children in Germany? : Nicole Mauer

The COVID-19 pandemic created substantial disruptions in the delivery of health services around the world. Reductions in hospital admissions have been reported for several conditions in the adult population;less evidence currently exists for children. To what extent such changes reflect a risk for patients due to unmet care needs, or a “correction” of previous overprovision of care has not been thoroughly examined yet. Based on complete national hospital discharge data, we compare the top 30 diagnoses for which children were hospitalised in 2019, 2020 and 2021 in Germany. We also analyse the development of monthly admissions between January 2019 and December 2021 for three tracers of variable urgency and severity. Total admissions were approximately 20% lower in 2020 and 2021 compared to 2019. The composition of the most frequent diagnoses did not change dramatically across years, although changes in rank were observed. The number of admissions for acute lymphoblastic leukaemia (tracer 1) showed a slight increasing trend and a periodicity prima vista unrelated to pandemic factors. Appendicitis admissions (tracer 2) decreased by about 9% in 2020 and a further 8% in 2021, while tonsillectomies/adenoidectomies (tracer 3) decreased by more than 40% in 2020 and a further 30% in 2021;for these tracers, monthly changes are in line with pandemic waves. Observed variations in child hospitalisations reflect the effects of pandemic mitigation measures and/or changes in demand. In Germany, inpatient care for critical conditions appears to have been largely upheld, potentially at the expense of elective treatments. Complementary data on ambulatory care and health outcomes would enable a better understanding of change in healthcare patterns and effects on children's health.

European support for improving health and care systems

Although the primary responsibility for health systems within the European Union (EU) lies with its Member States, the EU also has many tools that can support the strengthening of health systems. Many of the EU's tools can provide support even though strengthening health systems is not their primary objective, such as the European Semester, the Cohesion Policy Funds, Horizon Europe and the Recovery and Resilience Facility. The available tools address different parts of change processes. Making best use of these instruments typically requires combining various EU tools with different objectives across multiple stages of the change process. The need to combine diverse tools creates the challenge for Member States of being aware of many different tools and their potential to support health systems, and in aligning objectives and processes between health objectives and the requirements of those tools. There are some examples of technical assistance from the EU to help with doing this, although none are specifically focused on health systems strengthening. There is potential to combine support from the EU with support from other sources, such as national and regional instruments or other international bodies like the World Health Organization (WHO), although this also presents countries with the challenge of combining instruments with diverse objectives and processes. The EU's support to health systems respects the primary responsibility of EU countries for their own health systems. Nevertheless, being able to draw on EU support has been increasingly important, in particular for Member States that have joined since 2004, and will become even more vital in the coming years. As health systems across Europe deal with the consequences of the COVID-19 pandemic, there is scope for greater collaboration between individual countries and at EU level to make best use of EU tools to strengthen health systems.

A cross-country comparison on providing health services effectively during the first wave of COVID-19

At the onset of the COVID-19 pandemic, health care providers had to abruptly change their way of providing care in order to simultaneously plan for and manage a rise of COVID-19 cases while maintaining essential health services. Even the most well-resourced health systems faced pressures from new challenges brought on by COVID-19, and every country had to make difficult choices about how to maintain access to essential care while treating a novel communicable disease. Using the information available on the HSRM platform from the early phases of the pandemic, we analyze how countries planned services for potential surge capacity, designed patient flows ensuring separation between COVID-19 and non-COVID-19 patients, and maintained routine services in both hospital and outpatient settings. Many country responses displayed striking similarities despite very real differences in the organization of health and care services. These include transitioning the management of COVID-19 mild cases from hospitals to outpatient settings, increasing the use of remote consultations, and cancelling or postponing non-urgent services during the height of the first wave. In the immediate future, countries will have to continue balancing care for COVID-19 and non-COVID-19 patients to minimize adverse health outcomes, ideally with supporting guidelines and COVID-19-specific care zones. Many countries expect to operate at lower capacity for routinely provided care, which will impact patient access and waiting times. Looking forward, policymakers will have to consider whether strategies adopted during the COVID-19 pandemic will become permanent features of care provision.

Building on value-based health care: Towards a health system perspective

Preoccupation with the value created by health systems has been longstanding, and will likely only intensify given the ongoing health systems strains and shocks such as the COVID-19 pandemic. But the focus so far has usually been limited to value as seen from the perspectives of certain actors in the health system and/or to certain dimensions of value. In this policy brief we call for a shared understanding of value that embraces the health system in its entirety, including preventive services and other public health functions. We then define value to be the contribution of the health system to societal wellbeing. Any meaningful formulation of the concept of wellbeing includes health, and by extension health systems, as an important contributor to our wellbeing. Health improvement, responsiveness, financial protection, efficiency and equity are widely accepted as health systems' core contributions to wellbeing. Health systems can also contribute to wellbeing indirectly through the spillover effects that its actions have on other sectors. Health systems are shaped by a wide array of actors, including national policy-makers, purchasers, providers, practitioners, citizens and patients. These different actors make important but discrete contributions to value, so in order to maximize it, their actions should be aligned. The aim should be to create a value-based health system. A range of policy levers can be used to enhance value, ranging from cross-sectoral policies to involving patients in decision-making. While such levers normally focus on one or two dimensions of value, it is important to ensure that they do not undermine other dimensions or the efforts of other actors. Effective governance of the whole health system is needed to ensure that stakeholder perspectives and policy levers are aligned to promote a common concept of health system value and, ultimately, of societal wellbeing. There are governance tools, such as the Transparency, Accountability, Participation, Integrity and Capacity (TAPIC) framework, that can help achieve this. Moving towards a value-based health system will often be a gradual process, focusing first of all on the areas where it might make the biggest difference.