"Dräger: In Europe, the number of intensive-care beds per capita is very unequally distributed. In Italy, it is three times lower than here. In England, five times lower. The challenge in England will be greater than in Spain. And the situation in the U.S. is very alarming. The reporting system there is also underdeveloped."
https://www.forbes.com/sites/niallmccarthy/2020/03/12/the-co...
All seem to come from the same sources, a 2009 and a 2012 study. The Forbes article actually mentions an alternative source, an article from 2015 [2] which is actually looking at regional 2000-2009 data. You can also follow the links at Wikipedia [0].
For Germany, there are numbers from 2017: The German Office for Statistics is reported in 2019 28.031 ICU beds which is a rate of 33.7 per 100,000 inhabitants.
EDIT: This [3] WoPo article references data from 2016-2018: 93,000 ICU beds in total in the US. That's about 36 ICU beds per capita (aged 16 or older).
For comparison, Germany, based on the 28031 ICU beds and 70976000 inhabitants 16 or older [4] has 39,49 ICU beds per capita.
[0] https://en.wikipedia.org/wiki/List_of_countries_by_hospital_...
[1] https://www.sciencemediacenter.de/alle-angebote/fact-sheet/d...
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4351597/
[3] https://www.washingtonpost.com/business/2020/03/23/map-place...
[4] https://www-genesis.destatis.de/genesis//online?operation=ta...
Why would this be unique to germany. Can we just assume this is more or less identical everywhere?
https://en.wikipedia.org/wiki/List_of_countries_by_hospital_...
Based on these numbers and in light of the current situation in Spain, the situation in the UK will indeed get very difficult.
Source: https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...
There have been no cuts in NHS service. Sometimes I think I need to assign this to a keyboard macro because it's such a frequently repeated myth. The NHS has more funding now than it's ever had, it has been explicitly protected from budget reductions when every other government department has seen massive real cuts, and just last year has been given enormous spending boosts. NHS "cuts" are a bit like the gender pay gap - they exist only when statistics are abused to meet political and ideological agendas.
Or, you could equally ask why Germany and the USA seem to spend so much on healthcare. After all the UK spends about average for the OECD. And the USA spends the most of all by far so it should barely notice COVID-19 compared to other countries? I guess we'll see.
Addenbrookes Hospital in Cambridge (technically Addenbrookes Hospital Trust, comprised of several hospitals on one site) is the largest hospital in the UK. For the tax year 2019/2020, the available budget for capital expenditure (building, large equipment like MRIs etc.) was £0. (accurate prior to Covid-19)
Occasionally as a result of political manoeuvering (General Election campaigning) pots of money for very narrow purposes with a limited time window on them appeared, but in general things like ward refurbishments have been funded by charitable donations. Most worthwhile capital investments take more than a year, so a predictable capital budget is necessary to implement programs. Having no money for CapEx is not how you maintain a health service long term.
Yes, this is how such threads always go. It's a simple three step process:
1. Someone claims the NHS funding has been cut
2. I point out that's a lie, no such cuts have ever happened and in fact the budget has always gone up
3. Somebody else replies with: but it should have grown even faster.
The point I'm making is not about the correct level of healthcare spending, which is arbitrary and values-based as healthcare systems will consume however much money is given to them. Rather the persistent level of outright lying that accompanies any discussion of the NHS in Britain. It's absurd and quite obviously linked to a belief that misleading people is fine if it's for a 'good cause'.
But this behaviour has to stop. It isn't OK to lie even if the outcome might appear to be desirable (more political pressure for higher healthcare spending). People learn that they're being manipulated and support for the desired cause can collapse.
Having no money for CapEx is not how you maintain a health service long term.
I'll repeat this until I'm blue in the face. The NHS has more money now than it's ever had. Not only does the NHS have money for capex but it's been repeatedly allocated money specifically and only for capex, because NHS managers have a long history of preferring to divert spending on upgrades to other forms of spending - frequently salary increases.
It's bad management. The government attempts to combat this lack of forward thinking by earmarking of money specifically for upgrades (what you criticise here as "pots of money for very narrow purposes"). One of the first things Boris Johnson did is allocate a billion pounds to the NHS only for capex. Unfortunately it doesn't work:
https://www.hsj.co.uk/technology-and-innovation/exclusive-qu...
"Capital spending was particularly tight with only £150.3m spent from £354.1m of allocated funding ... funding to help NHS trusts to become more digitally advanced accounted for most of this capital underspend. The DH planned to spend £116.2m of capital on these trusts in 2016-17 – instead it spent nothing."
The idea the NHS doesn't have money for capex is just another piece of misdirection. It refuses to spend on upgrades even when central government is trying to force its hand, because it knows that the result is No 10 will blink and give up, which is what happens:
"The money was not allocated elsewhere but “as with all Department underspends, was available to offset pressures in other parts of the system”, she said."
Doctor and nursing salaries are pretty low in the UK, if management is diverting capital expense money to salary increases, they are doing a poor job of it.
https://fullfact.org/health/spending-english-nhs/
"Looking at the wider UK, the amount spent on health has been increasing over the long-term. That’s true whether it’s expressed in cash, cash adjusted for inflation, per person, or as a proportion of the size of the economy."
Population growth puts pressure on public services. The British people have been asking for reduction in population growth for a long time, partly out of concern for the state of the NHS, yet of course have been repeatedly denied by the EU and their own political classes. 4 years after voting to leave the EU largely to get a grip on the ever-increasing cost of public services they still haven't been allowed that.
Doctor and nursing salaries are pretty low in the UK
They're extremely high. The average pay for specialist consultants in the NHS is £120,000 or approximately 6x the average salary. This is dramatically higher than in say, Germany, where specialists earn 80,000 Euro on average. That's £71,600 or a bit less than 60%.
https://www.google.com/search?hl=en&q=average%20salary%20for...
https://www.medscape.com/slideshow/2019-uk-doctors-salary-re...
if management is diverting capital expense money to salary increases, they are doing a poor job of it.
They've done an excellent job of it. From 2010:
https://www.telegraph.co.uk/news/health/news/8206972/Billion...
"Billions of pounds spent on improving NHS hospitals has mostly gone on staff salaries while productivity has fallen over the last decade, a key National Audit Office (NAO) report has found."
"Between 2000 and 2009 the NHS workforce grew from 1.1 to 1.4 million - almost a 30 per cent rise. That included an extra 12,500 consultants, whose average pay rose from £71,900 to £120,900 over the same period - a 68 per cent increase. Doctors' pay rose by 48 per cent, nurses' and midwives' by 36 per cent and managers' by 34 per cent"
Health costs have been rising everywhere in the world and this has little to do with population growth (that's actually good because young people pay taxes), but more with rising life expectancies and the resulting average age. Every country has been experiencing the same trend (the US being an exception likely because of privatized healthcare): https://en.wikipedia.org/wiki/Healthcare_in_Germany and those country have pretty different population developments.
Also you are comparing a Facharzt salary to a consultant, that's not a fair comparison. You should compare to a specialist and look what do they earn in the UK? £40,037 to £74,661. https://www.healthcareers.nhs.uk/explore-roles/doctors/pay-d...
That looks awfully similar to what a Facharzt earns (actually with the current rates the German earns significantly more more): 70.000 – 95.000 Euro https://www.praktischarzt.de/arzt/gehalt-arzt/
Please, just stop this. Departments asking for more money than they know they'll be allowed and then getting less is a universal truth of organisations, both governmental and corporate. It's called negotiation. Being given more money than you had before is not, and never will be, a "cut" in the English language. That word has a precise meaning and it simply doesn't apply here.
Likewise the NHS wasn't asked to find 20 billion in "cuts". That doesn't even make sense. You can't increase your own budget by reducing it. They were told that if they really needed that much they would be expected to find it through increased efficiency. Keeping a check on NHS waste is a key function of elected governments which voters expect them to fulfil, simply writing them blank cheques has been tried before and didn't work (as in costs went up, but healthcare outcomes didn't or didn't by anywhere near as much).
Health costs have been rising everywhere ... more with rising life expectancies and the resulting average age
And the NHS budget has been rising too.
Also you are comparing a Facharzt salary to a consultant, that's not a fair comparison
Alright, fair enough, then focus on the original statement - doctors and nurses get anywhere between good and extraordinarily good pay relative to the average salary in the UK. There are doctors in the UK earning significantly more than the Prime Minister, and their pay went up significantly during the last Labour government (not sure about this one, didn't look, but I assume pay inflation has been only slightly lower).
The point is that significant amounts of the money given to the NHS ended up being spent on increased OpEx like salary increases, rather than CapEx like capacity increases or efficiency improvements. Obviously the NHS must raise salaries at least in line with inflation, and really more in line with global healthcare inflation to avoid brain drains. But the idea its hospitals are run down because evil central government keeps cutting its budget is just far wrong.
Plus Britain is getting somewhat older, and somewhat sicker (partly because of medical advances meaning that previously-fatal conditions are now chronic and need ongoing treatment). And we can treat more now, so there is more demand.
Bluntly, the proportion of GDP which needs to be allocated to healthcare to maintain a good quality service is rising unsustainably in all countries. The NHS is beating CPI inflation (and in doing so doing way better than other parts of government: local government has seen >25% real terms cuts, which has trashed the social care system amongst other things) but not nearly enough to keep up.
If Germany have provisioned 5 times more ICU beds than they generally need, I can see why their costs might be higher
-Under provisioning for surges (not even Covid, even just a sudden emergency of another sort, a bad flu season, big accident, terror event, whatever)
-Going longer between maintenance intervals than is recommended
-Delaying ICU admission longer than is strictly recommended
-Relocating ICU equipment as needed more than other countries feel comfortable doing
-Using more reliable ICU equipment (does the German figure include any older and potentially less reliable gear in the former communist east?)
-Have less need among population for ICU
On the last point, Germany has accepted by far more refugees from MENA war zones than any other European country and I would not be surprised if this resulted in higher emergency medicine use.
Also a quick Google shows Germany is a bit older with 22% of the population over 65 vs 18% in UK.
None of this is to say Germany isn’t over provisioned but it is probably not 5X over provisioned, if it is.
However, let's not forget historical factors and was case of many countries having armies in Germany for legacy war reasons and that may well of seen the mentalities to have a higher number of such beds than most places.
Investing in availability costs, and the UK has been brutally cutting NHS funding in the past years or even decades.
Another aspect is that health care in Germany is much more decentralized, and so local hospitals have to absorb spikes in demand more by themselves, distributing patients to other facilities is only done in very rare cases (usually when specialist treatment is necessary). You cannot operate at > 80% utilization and still be able to absorb spikes in demand.
Another anecdote, whenever I wanted something "unusual" I was denied, and the person "in charge" needed to ask a supervisor. E.g. in an (upscale) hotel I wanted to see a different room for my next stay, took some time to ask different supervisors but in the end it was "impossible". In Germany the person at the reception desk would decide if this is possible or not and most like show me a room.
(Yes all anecdotal and colored by my cultural perception).
It's also completly possibile that you're an outlier German that is frustrated with the current rules. For sure, I've seen that in spades. it isn't the mainstream though.
I don't know why this is so different in Germany. I've more often observed the inverse - where people (mostly well-dressed middle-aged men, for whatever reason) are extremely rude and condescending towards secretaries, ticket collectors, etc.
[1] I don't think that's idiomatic English, which illustrates my point.
[1] https://www.gesundheitsstadt-berlin.de/oecd-studie-deutschla...
Consider that in the last few weeks the NHS doubled its ICU capacity. The term "ICU bed" conjures up images of something surrounded by über-complex equipment but it can mean other things, which is why it seems able to flex so fast.
As far as I can tell, so far in this pandemic, there haven't been any stats that can be totally trusted or compared between nations - on anything at all.
this is correct in general. i don't think we'll have a clearer picture until at least autumn by which time some basic data has been collected and analyzed. then the multi-year governmental and private inquiries will surely follow, shedding even more light on the whole situation. i expect to keep hearing about this disease for years and years from now. but this too shall pass at some point.
I feel like that question is asked the wrong way around because you are assuming England has "exactly enough", that's how you end up with Germany supposedly "running five times more beds than it needs".
But there's good reason to believe England has not enough ICU beds, even outside of a pandemic, the result of years of austerity cuts to the NHS [0].
There's also the fact that Germany is a healthcare powerhouse. Often forgotten among all the "cars and engineering" exports, but pharma and vaccines are the other two German top exports [1]
These are fields you can only really innovate in if you have a matching clinical and medical infrastructure behind it, which Germany has.
It's this combination that allows Germany to have such low fatality rates [2]. To put them in numbers: The UK right now sits at 11 deaths per 1m population, Germany at 5, and that's with Germany having tens of thousands of more cases [3].
[0] https://www.theguardian.com/politics/2019/jun/01/perfect-sto...
[1] https://oec.world/en/profile/country/deu/
The UK has done around 110k tests, Germany more than 400k. Don't confuse positive test results with actual infections. If the UK tested more, it'd very likely have more "cases".
With that, who really thinks Russia has so few cases compared to the rest of the countries?
Even deaths, which you would of thought would be pretty clear cut, some countries will not count deaths with underlying conditions when many do. Then you have those who died at home and nobody knows about it.
I do know one thing, I feel for the postal workers in months ahead as there job will become a lot more morbid seeing who's letterbox is rammed and with that, possible dead people inside that nobody knows and for those postal workers - they will be the ones raising the alarms.
I don't, I'm mostly going by deaths/1M pop, and afaik even if the UK tested more, that number wouldn't change and still be more than double that of Germany.
So Germany must do something right that the UK doesn't.
Maybe it's the extra ICU beds, maybe it's the rapid testing, most likely it's a combination of both of those in addition to the better funding?
... or wrong. Italy e.g. tests dead people for Coronavirus, Germany might conclude in many cases that people with prior issues died from those issues. I know Austria is very reluctant about this.
Another poster mentioned the decentralised nature of the German system, that has been mentioned as one of the reasons why Germany was able to test so much.
It's over 400k total as of March 23rd and 100k in the week of 20th. https://www.zeit.de/wissen/gesundheit/2020-03/coronatests-de...
> Another poster mentioned the decentralised nature of the German system, that has been mentioned as one of the reasons why Germany was able to test so much.*
Seems to be, but that makes Austria's excuses look a bit poor. Here they have a similar decentralised system, but they're claiming that they don't get enough test kits on the market and that's why they're now testing 3k-5k a day despite having lab capacities >15k/day. If Germany can get them, Austria can, too - money shouldn't be an issue.
The standards for "it's good enough" are vastly different in these countries.
It's definitely not a deliberate "for a case like this" precaution but an emergent outcome of the specifics of how hospital funding is done and had been decried as a problem to be solved by should of the usual suspects.
in my experience, Germany is quite conservative (lagging behind in smoking bans, preferring cash over cards until the coronavirus hit), but wants to do the right thing (look at e.g. solar power subventions). them being a federal republic means they have similar jurisdictional issues as the US, but less hamstrung by a crippling fear and distrust in the federal government. those traits, if i'm accurate, would also explain it.
(what is still there as a disparity between some western states and eastern states.)
Which said infrastructure has no legacy from that era and completely overlook the cold-war build up and associated facilities and infrastructure of that era born out of that period. Equally let us not forget that Germany was upto not long ago - curtailed in what it could invest in military and not having that burden saw a shift into area's they could and medical and industry did well. More so when in many parts they had a clean slate to build up from.
I'm sure many aspect you mentioned are true - , however the drive for solar was born out of a distrust in nuclear and saw a rise in coal plants - which still has an effect today upon the climate of Europe as many (near on all) are located upon the borders, so that issue shifted and needed to be addressed and solar/wind was the right logical direction for them. But then - NO country is perfect or doing it perfect.
But the Germans are trying and done wondrous progress in many area's, let us not forget when they reunified the impact upon their GDP was negligible - that in itself was impressive and whilst in some parts of Germany that legacy still has more of an impact socially, it's progressed a long way and probably more than other countries would of had they been in a comparable situation.
>(what is still there as a disparity between some western states and eastern states.)
Yes - that is a product of legacy.
How could anyone argue that once in a while there won't be enough beds to save everyone's life?
The closest things I can think of non healthcare is that airbags are designed for 5, 50, and somewhat for 95%ile individuals. But I think it's actually impossible to develop for everyone due to mechanical restrictions.
https://www.cambridge.org/core/journals/disaster-medicine-an...
> The median number of full-feature mechanical ventilators per 100,000 population for individual states is 19.7 (interquartile ratio 17.2–23.1), ranging from 11.9 to 77.6
Edit: WSJ opinion linked to a NIH study from 2012.
https://www.wsj.com/articles/americas-intensive-care-dividen...
> A 2012 review [1] in the journal Current Opinion in Critical Care found that the U.S. has 20 to 31.7 ICU beds per 100,000 people compared to 13.5 in Canada, 7.9 in Japan and between 3.5 and 7.4 in the U.K. Differences in how countries define “ICU” account for some of the disparity, the article notes, and the U.S. needs more ICU beds because it has a higher incidence of chronic conditions like heart disease.
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551445/?mod=ar...
In summary: Data for the US from 2016-2018 suggest 93,000 ICU beds total, that is a ratio of 28.43 per 100,000. (research referenced in WoPo article linked in the comment below).
For comparison, Germany (official 2017 data) has 28031 ICU beds total, a ration of 33.76 per 100,000.
Both countries likely have the highest ratio in the world at this time.
In terms of ICU beds, for once this is where the us health care system is in reasonable shape. iCU beds are very profitable and we spend way more then Europe on health care, so there is a abundance of them in many regions. New York and georgi look constrained, but California, Florida and Colorado look solid from numbers I saw yesterday.
General beds are better in Europe then in the USA.
The USA also had the highest ratio of ventilators to people - in fact the number that he gives as impossible to produce in a year was in the US reserve at the start of the year - but it’s unlikely to be enough.
As for as scaling up production for ventilators.... just watch. I think you will see a similar effort to the tests scaling up. There will be a lot of press on it, but I would not be surprised to see new machines scale within this month. Probably not enough to save all lives, but more this this individual thinks is possible or conceivable will me from China and the US.
For whatever reason, Germany has historically been very bad about scaling production in emergencies, even during life and death moments (is, wars).
I've seen estimates everywhere between 90 to 99.9% of cases going untested.