Health system characteristics and COVID-19 performance in high-income countries

Abstract Background The COVID-19 pandemic has shaken everyday life causing morbidity and mortality across the globe. While each country has been hit by the pandemic, individual countries have had different infection and health trajectories. Of all welfare state institutions, healthcare has faced the most immense pressure due to the pandemic and hence, we take a comparative perspective to study COVID-19 related health system performance. We study the way in which health system characteristics were associated with COVID-19 excess mortality and case fatality rates before Omicron variant. Methods This study analyses the health system performance during the pandemic in 43 OECD countries and selected non-member economies through three healthcare systems dimensions: (1) healthcare finance, (2) healthcare provision, (3) healthcare performance and health outcomes. Health system characteristics-related data is collected from the Global Health Observatory data repository, the COVID-19 related health outcome indicators from the Our World in Data statistics database, and the country characteristics from the World Bank Open Data and the OECD statistics databases. Results We find that the COVID-19 excess mortality and case fatality rates were systematically associated with healthcare system financing and organizational structures, as well as performance regarding other health outcomes besides COVID-19 health outcomes. Conclusion Investments in public health systems in terms of overall financing, health workforce and facilities are instrumental in reducing COVID-19 related mortality. Countries aiming at improving their pandemic preparedness may develop health systems by strengthening their public health systems.