Published by: China-CEE Institute Nonprofit Ltd. Telephone: +36-1-5858-690 E-mail: [email protected] Webpage: www.china-cee.eu Address: 1052, Budapest, Petőfi Sándor utca 11. Chief Editor: Dr. Chen Xin ISSN: 978-615-6124-43-2 Cover design: PONT co.lab Copyright: China-CEE Institute Nonprofit Ltd. The reproduction of the study or parts of the study are prohibited. The findings of the study may only be cited if the source is acknowledged. European National Health Systems in Fighting against the COVID-19 Pandemic Chief Editor: Dr. Chen Xin CHINA-CEE INSTITUTE Budapest, December 2020 Content Preface ............................................................................................................. 3 Kaixuan LI Why the Italian NHS Has Rapidly Reached Its Maximum Capacity in COVID- 19 Pandemic? ......................................................................................... 5 Xiaoyu ZHU& Yujie GAN NHS System Under the Shocking Coronavirus: Overview, Response and Evaluation ............................................................................................ 19 Bogdan J. GÓRALCZYK Coronavirus in Poland: Domestic Solutions, International Impact ................... 42 Zeren LANGJIA The Coronavirus Outbreak and Its Containment Measures in Benelux Countries ............................................................................................................. 61 Yun LI & Hong SHEN COVID-19 Situation in Spain: Overview, Response and Evaluation ............. 100 Xiepu YANG & Rongxin HUA An Analysis of the COVID-19 Outbreaks in Germany: Why the Death Rate in Germany Is Relatively Low? .............................................................. 120 Shuyi PENG Why France Failed to Contain the COVID-19 Pandemic .............................. 144 Mario ESTEBAN & Ugo ARMANINI China-Spain Relations amid COVID-19 in a Comparative Perspective: An Enduring Partnership Facing Potential Uncertainties ........................... 163 Junchi MA New Wine in Old Bottle: Hungarian Anti-Epidemic Measures and Their Political Implication ........................................................................... 188 1 2 Preface Health systems are responsible for delivering healthcare services that are supposed to improve, maintain and restore the health of individuals and their communities. Nevertheless, the COVID-19 pandemic has brought unprecedented pressure on the National Health Systems across Europe and great impact on national healthcare policies. Therefore, it is of great importance to have a better understanding of how individual European countries and their national health systems react to the pandemic as the systems differ from one to another. This book provides a brief analysis on the European countries’ National Health Systems against the backdrop of the coronavirus pandemic and the attendant uncertainties. The papers in this collection were written during the second season of the year, which was the critical and challenging moment for (mainly Western) European countries and their national health systems to contain the coronavirus outbreak, and then published as working papers of China-CEE Institute. Considering the time sensitivity, some of the ideas and data covered in the papers may need to be updated, but still the papers are able to present a general overview of National Health Systems of some European countries. The views in the book are represented by the individual authors instead of the China-CEE Institute. The China-CEE Institute, registered as a non-profit limited company in Budapest, Hungary, was established by the Chinese Academy of Social Sciences (CASS) in April 2017. The China-CEE Institute builds ties and strengthens partnerships with academic institutions and think tanks in Hungary, Central and Eastern European countries, as well as other parts of 3 Europe. The China-CEE Institute aims to encourage scholars and researchers to carry out joint research and field studies, to organize seminars and lecture series, to hold some training programs for younger students, and to publish academic results, etc. I hope this collection will be helpful for enriching the knowledge of the national health systems of European countries and promoting the mutual understanding between China and Europe. Prof. Dr. CHEN Xin Executive President and Managing Director, China-CEE Institute Deputy Director General, Institute of European Studies, CASS 4 Why the Italian NHS Has Rapidly Reached Its Maximum Capacity in COVID-19 Pandemic? LI Kaixuan1 Abstract It seems paradoxical that in Italy, a European country with a world-class health care system, the fatality rate of COVID-19 patients has exceeded 10% on 25 March, 2020. Obviously, the Italian National Health Service (NHS) has already reached its maximum capability. In addition to the issue of aging population, the Italian NHS is facing the shortage of hospital beds and crucial medical equipment. The widening regional gap under the decentralized governance structure, constant public health cost containment, as well as the relatively low integration of General practitioners (GPs) practices have caused further concerns. Italian NHS can hardly beat the Coronavirus alone. As the COVID-19 disease has already become a global pandemic, only by deepening international cooperation can the world win the battle and contain its consequences. Key words: Italian NHS; COVID-19; Regional Gap; Cost Containment; International Cooperation 1. Introduction Since the first local case has been found in Lombardy in mid-February 2020, Italy has become Europe’s hardest-hit in the COVID-19 pandemic. On 25 March, 2020, the infected cases have reached 74,386 and the death toll is 7,503. The fatality rate reported between March 1 and March 25, 2020, has increased from 5% to 10.08% of actively infected patients. Currently, this percentage is too much higher than any countries in the world. It seems that 1 Li Kaixuan, Associate Research Fellow, Academy of Marxism of the Chinese Academy of Social Sciences. 5 there is a paradox between the high fatality rate and the world-class health care system of Italy. In fact, seven days at the initial phase of the pandemic, the health system has rapidly reached the limit in northern Italy. The shortage of ICU beds, medical staff and protective supplies has exposed from the beginning. In addition to the exponential growth of severe cases among aging people, it is another important cause that has dragged the Italian NHS in dilemma. According to the assessment published by Lancet online in November 2019, aging population and gradual decrease of public health financing are two main concerning issues for the Italian NHS. These issues will pose challenges to the future of Italy’s health status. Unfortunately, huge challenges are coming too soon. Furthermore, the decentralization of NHS and the low integration of primary care in Italy might also have limited the capability of Italian NHS to deal with the new risk. Both the national government and the regional authorities have announced a series of countermeasures to slow down the fast growth of newly infected patients and intensive care cases. Local Health Authorities have implemented several measures to expand their capability to save lives. However, as the situation is becoming more emergent, the Italian NHS system has been at its maximum capacity. Hence, international assistance and cooperation are crucial to prepare Italian NHS to meet this unprecedented challenge. 2. Paradox and dilemma of Italian NHS in the COVID-19 Pandemic In 1978, Italy’s tax-funded National Health Service (NHS; Servizio Sanitario Nazionale, SSN) was established. At the same time, health insurance funds were abolished by the reform. The main aims of NHS are to guarantee uniform levels of care throughout Italy, equitable access to services for all Italian citizens and legal residence in Italy, as well as health spending control. Furthermore, the Italian NHS claims that it also has three 6 guiding principles. The first one is universality—— all citizens have an equal right to access services provided. The second one is solidarity—— every citizen contributes to funding the NHS based on their means, through progressive taxation. The last one is uniformity——the quality of the services provided by the NHS in all regions must be uniform. After reforms in 1990s, the Italian NHS was reshaped and became more efficient. In 2000, Italian health system ranked second in the world by the World Health Organization. Although Italy has introduced stringent cost cutting in health-related reforms, its NHS has maintained its world-class level of performance. In 2015, OECD and the European Observatory on Health Systems and Policies, affirmed Italian NHS’s performance, given its effectiveness, access and resilience. In November 2019, Lancet published the assessment on personal health- care access and quality with the Health-care Access and Quality (HAQ) Index for 195 countries and territories online. According the assessment on Italy, Italian NHS provides world’s leading services. In 2017, life expectancy ranks Italy eighth globally for females and sixth for males, and an HAQ Index score of 94.9 in 2016 compared with 81.54 in 1990, keeps Italy ranked as ninth globally.1 The assessment, presented several critical data from 1990 to 2017, including causes of death, years of life lost, years lived with disability, disability-adjusted life-years (DALYs), life expectancy at birth and at age 65 years, healthy life expectancy, and Healthcare Access and Quality (HAQ) Index.2