What is changing due to the corona pandemic? What consequences does it have for the lives of individuals, and what impact will it have on society, politics, the economy, research, and culture? In the current interview of the campus.leben series “Corona – Ask the Experts” Leon Holly speaks with Carolin Auschra, a business economist at the Management Department of the School of Business and Economics at Freie Universität, about this stress test for the German health care system, the current status of the system with regard to treatment and care, and possible structural changes after the crisis is over.

Dr. Auschra, for a long time, many experts had been predicting that a new pandemic could break out at any time. How well do you think the German health care system is prepared for the emergency situation that is unfolding now?

My impression is that the German health care system is very well prepared in an international comparison. All the patients receive the necessary care, and physicians still do not have to triage, which according to media reports, was required in hospitals in Italy, Spain, and France, where physicians were forced to make decisions about who could be treated and who could not due to limited human resources or the lack of ventilators.

The double provision in Germany, i.e., the parallel structure of outpatient and inpatient treatment, which is often criticized, could prove to be an advantage, since it allows for more resources to be used for care. That only applies under the condition that the necessary protective material is provided promptly. The same thing applies to the high number of intensive care beds in Germany compared to other countries.

I must point out that we are still at the beginning of the pandemic in Germany. However, I am relatively optimistic about the many measures that are currently being taken to counter the pandemic.

Could you give some examples of what you mean?

The measures include many things that would normally have taken a long time to implement. Hospitals are setting up new intensive care beds, in spite of possible financial losses. In addition, the DIVI (German Intensive Care Register) has been set up, which enables hospitals to exchange information better. This will make it easier to see where empty intensive care beds are available, and COVID-19 patients can be distributed centrally. A draft regulation was prepared to make reporting to DIVI mandatory.

On the other hand – what are the shortcomings of the health care system?

The same weaknesses that existed before. On the one hand, there is a shortage of nursing staff, and professional nurses are underpaid, both in the inpatient sector and in the outpatient nursing service. That exacerbates the situation because the COVID-19 cases are particularly common there. We can see that already.

In addition, the working conditions in the public health service are unattractive, especially in the health authorities. The payment for physicians employed there is often worse than in hospitals or private practices. That is why, for example, these organizations already had problems filling vacancies.

Existing pandemic plans and their implementation will also have to be examined and discussed, including the storage of protective materials. The likelihood of a pandemic, the costs of storage and procurement, and the short-term availability of materials must all be weighed against each other.

Is there a supply gap in Germany? For example, suppose someone who has pneumonia caused by COVID-19 needs to be hospitalized: Would it be better if they lived in the country or in a big city?

There is not only a supply gap between city and country. Even in large cities, there are certain regions that are less well equipped than others. However, the number of regions in Germany where there is an acute shortage in the outpatient sector is rather small. But even in these regions, it will probably not play a major role in the current case of COVID-19, as it is currently possible to transfer patients from one hospital to another. The hospitals are cooperating to find free beds, which in turn has the advantage that patient transport can specifically target hospitals with capacities.

What changes do you foresee will be made in the health care system after the corona crisis?

In Germany health care is primarily organized regionally. In the event of a pandemic, you have to think across regions, as we see now in the networking of hospitals. In addition, medical practices could network via the statutory health insurance associations in different districts or counties and exchange information about where corona tests can be carried out.

A good question is whether not all, but only certain selected medical practices should come into contact with COVID-19 patients. This would also be an important issue to discuss for the future.

On the other hand, larger issues such as digitalization and networking, have already been discussed for about ten years and more. Maybe the corona crisis will lead to some fundamental changes. I am thinking, for example, of the widespread use of video consultations. And of course I hope that the working conditions and payment for professional nurses and caregivers will finally be improved!

Could COVID-19 have a catalytic effect and accelerate change processes?

Organizations and systems often change in times of great crisis because they are forced to adapt quickly to the new situation. It is still uncertain whether the network structures in the health care system that are currently being set up nationwide will survive the crisis.

There are parallels to other areas where a lot is currently in motion. For example, will there be more opportunities in the future for digital teaching at the university or for working at home? The crisis can greatly accelerate many health care processes, but it is not at all clear whether this will change anything over the long term.

What recommendations can you make based on your research?

I have been dealing with so-called grand challenges, such as those being investigated through the Berlin University Alliance, for a long time. Grand challenges are complex problems of global scope, such as climate change or poverty in developing countries. Many key actors need to be involved in order to make progress in tackling such challenges.

COVID-19 is obviously this type of challenge. Therefore, I am currently working with two colleagues to examine the different and sometimes conflicting narratives and solutions offered by the various social actors in the current situation, for example, representatives from the government, business community, or medicine. We are currently in the data collection phase. We will probably be able to say more about that four weeks from now.

The original German version of this article was published on April 7, 2020, in campus.leben, the online magazine of Freie Universität Berlin.