Ricardo González Ricardo González, Director of Sectoral and Regulation Research at MAPFRE Economics.


Assessing the effectiveness of a healthcare system is no easy task, even less so given the current context, as we remain mired in an abnormal situation as a result of the COVID-19 pandemic. No one disputes the fact that measures must be taken at this point to strengthen healthcare systems, and a proportion of the economic reconstruction funds being approved globally will be set aside for that objective.


However, this is not just a capacity problem for healthcare systems, although the speed at which the disease can spread means any healthcare system may become overwhelmed if no other steps are taken to prevent it from spreading. Assessing the effectiveness of a healthcare system in the context of a pandemic is like assessing the effectiveness of a dam in a seaport when a tsunami strikes. Neither dams nor healthcare systems are designed to cope with events of such a catastrophic nature. In these situations, early warning systems and the quick adoption of appropriate measures are vital to safeguarding the population. This entails regional, national and international infrastructure and organization, which transcends healthcare systems.


The effectiveness of healthcare systems tends to be assessed on the basis of indirect indicators, with strong performance attributable to well-equipped and well-orchestrated systems. The results of these assessments always rank healthcare systems in Japan, Switzerland and South Korea at the top of the table. Italy and Spain tend to be well placed, often ahead of the United Kingdom, France and Germany.


However, these countries are performing very differently in terms of the spread of the pandemic. Japan and South Korea have undoubtedly done the best job of controlling the pandemic, as demonstrated by indicators such as number of deaths per 100,000 inhabitants (less than one) and the number of diagnosed cases, according to information provided by Johns Hopkins University. In contrast, indicators in Italy, Spain, the UK and France clearly show the situation in these countries to be significantly worse (all above 40 deaths per 100,000 inhabitants). This reveals a lack of correlation between the effectiveness of healthcare systems and the evolution of the pandemic. The same is true of Switzerland — a significant example with around 22 deaths per 100,000 inhabitants and one of the best healthcare systems in the world.


Germany is notable for its lower rate of 10.32 deaths per 100,000 inhabitants, despite the country having one of the oldest populations on the planet. This is in contrast to the significantly higher rates in the United Kingdom (58.85) and France (43.05). Germany was swift to react and proved that it was capable of testing its population (in its own hospitals), making use of the country’s wide network of laboratories. This enabled the country to more easily detect and isolate diagnosed cases in order to prevent infection, advising those who may have been infected to quarantine themselves and get tested. This included health workers, who have been a major vector of disease transmission in some countries lacking the means to do the same. Germany therefore possessed adequate means and heeded the experience of northern Italy, which served as an early warning sign.


Other notable cases include Greece and Portugal, with 1.67 and 13.85 deaths per 100,000 inhabitants, respectively, in contrast to the data from Italy (55.39) and Spain (58.02). This is in spite of the healthcare systems of the latter two countries having a higher effectiveness rating, being counted among the ten best in the world according to the IEHS — an indicator developed by MAPFRE Economics. Greece and Portugal’s ability to react, understand the extent of the problem and take appropriate lockdown and social distancing measures is noteworthy in this regard, as it had a significant impact in terms of controlling the pandemic. The same can be said of some Eastern European countries, such as Bulgaria and Romania.

Therefore, in addition to the degree of effectiveness of the healthcare systems, there are various other factors influencing the spread of the pandemic, including: the population’s demographic profile; the promptness with which distancing and lockdown measures were implemented; the capacity to research, make and supply adequate medical and diagnosis equipment; the presence of urban hubs with large population centers; whether or not the country is a focal point with international airports; and a host of other factors affecting the various levels of severity of the situation in different countries.


Experience is ultimately proving that a vast array of measures can be adopted to control mass infection. These go beyond strict lockdown measures for the population—which are damaging to the economy—and include the mandatory use of face masks in crowded enclosed spaces, such as public transport; banning events with large gatherings of people; carrying out testing, tracing, and selective quarantining; and border control, among others. This must all be without prejudice to the possibility of finding an effective vaccine that can be administered to a large proportion of the population, with the aim of achieving herd immunity, preventing the disease from claiming an unthinkable number of victims or overwhelming our healthcare systems.