THE ORGANISATIONAL IMPACT OF COVID-19 on health systems and health sector ecosystems – a German perspective AUTHOR Michael Thiede
PEER REVIEWER: Waasila Jassat
EXECUTIVE SUMMARY The analysis of embedded health sector ecosystems allows the identification of changes stimulated by the COVID-19 pandemic as an external shock and a stressor. This text reflects on selected aspects of a project assessing the impact of the COVID-19 pandemic on core functions and processes of the German social health insurance (SHI) system and on ambient ecosystems, i.e. ways in which people collaborate towards common economic, political, social, organisational and psychological goals within networked structures. The pandemic has so far hit Germany less hard than other European countries. The ecosystem approach allows the analysis of the degree of resilience as a result of the complex network of relationships between actors within the healthcare system and related areas of society and the economy. Evidently, the decentralised structures of the system facilitated the successful handling of the pandemic in its initial phase. Three main supportive arguments come to mind here: the sturdiness of the national system follows from differentiated regulations at the level of the German Länder; it is supported at the local level by distributed health authorities and largely managed through the self-governance structures of the SHI. The dichotomy between ambulatory patient care on one hand and hospital care on the other hand constitutes a barrier to flexible solutions. Overall, weaknesses of the health system that existed before the crisis have become visible as if under a magnifying glass. The pandemic has also accelerated some developments in health policy that had previously been longer-term ‘works in progress’.
BACKGROUND German society appears to have to shoulder a lesser disease burden attributable to the COVID-19 pandemic than other European countries. This paper focuses on core functions and processes of the German health system and on corresponding social ecosystems within and beyond the health sector. It is based on an ongoing research project that analyses the wide-ranging effects that the COVID-19 pandemic has had on
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2 0 2 0 SOU T H ERN AFRICAN H E A LT H JO UR N A L P U B L I S H E D B Y T H E B O A R D O F H E A LT H C A R E F U N D E R S
