I don't know why you are voted down. This is very much true for The Netherlands as well. Ever since the year 2000, possibly before, ICU beds have been scaled down.
Diederik Grommers, one member of the Dutch Outbreak Management Team (OMG) states: "it doesn't matter if you're vaccinated or not; 60% of the beds are occupied by vaccinated people; the problems we will encounter in the coming weeks are caused by the fact that we totally hollowed out our health care" [0].
The Netherlands has about 6 ICU beds per 100.000 citizens. Germany has almost 30 ICU beds per 100.000 citizens [1]. Now I know Germany did accept patients from The Netherlands on their ICUs and perhaps Germany is doing the same for other countries, so perhaps that is causing a capacity problem in Germany as well.
Thanks, that was an interesting video. I had to rely on auto-translated subtitles but from the little Dutch I can understand, it seems like they got the gist across.
Yeah, Germany has a ton of ICU beds in comparison, and yet, we're struggling exactly the same as any other country. I find it strange, too. In early 2020 I expected we'd see big differences between different countries based on ICU capacity, but we saw the same story everywhere (regional overload around the peak of a wave), with a few minor differences (whether some patients are transferred within the country or to other countries). Perhaps countries have different standards for when they put patients in ICU's, allowing hospitals (and governments) to always operate close to capacity? Would be one explanation, but I really don't know.
High total number notwithstanding though, our ICU capacity actually decreased during the pandemic, see:
The graph under "Gesamtzahl gemeldeter Intensivbetten" shows total capacity (light blue) + emergency reserve (green), dark blue is occupied beds. There was a pretty sharp drop-off in the total capacity a year ago, and a slower decrease all throughout 2021. Apparently, that's mostly due to nurses quitting in droves since the pandemic made their already bad working conditions even worse.
Our politicians didn't lift a finger to prevent or revert this, and now they're blaming a minority for this massive, massive failure. Just makes me really angry, I'll take downvotes for that if I have to :)
> Perhaps countries have different standards for when they put patients in ICU's, allowing hospitals (and governments) to always operate close to capacity? Would be one explanation, but I really don't know.
There's different standards in different countries for sure. In The Netherlands there's a focus on quality of life. If a patient cannot have a decent quality of life after staying on ICU, there's a preference to provide the patient with palliative care instead. In (e.g.) Italy this approach would not be accepted.
The number of ICU beds may have been inflated. At the start of the pandemic, hospitals had to report available ICU beds, and they received money for the number of beds they reported. I know of two hospitals that reported all of their beds (the physical objects) when the intention of the law / regulation was to have only those beds reported that could be operated / staffed.
Counter argument: Medical personel is hard to find and expensive, as is IC infrastructure. Why would we've needed to keep spare IC capacity for decades only to find out we need it in case of a pandemic? The German argument could be re-constructed into an argument that any country will run into IC shortages regardless of the level of IC availability. In an exponential curve it's only three or four cycles (8-12 days?) away, regardless of capacity. Hence, keep your IC capacity at regular efficient rates and use vaccination to get out of the hot seat. IC's save some but lose many. Vaccinations save many.
I can't say that I like the Dutch approach to covid in general, but in my first job I was deep into governement budgetting of hospitals (just before the introduction of the current Dutch reimbursement system) and it was a whole lot about 'keeping beds' and keeping patients in them to fulfill the budget. That was not what I'd call a generally efficient system. Even the health outcomes were worse since outpatient treatments usually have fewer side effects. What I've learned in that job is that doctors are like people. They respond to incentives. If that incentive is to have beds filled with people, you get just that. Beds with people.
You can’t throw a stone without hitting a nurse in the US, but I’m guessing they’re paid far better here as well just as doctors are.
I know Germany has a mixed system but it seems to me that socialized medicine keeping costs down slowly erodes care. The increase in costs in the US is also unsustainable. There might be a happy medium in there but it might be too early to tell.
> I know Germany has a mixed system but it seems to me that socialized medicine keeping costs down slowly erodes care.
You can see this happening in Canada too. We have a hybrid system in healthcare where the majority of critical care is paid for via taxes/government subsidies however secondary/tertiary stuff is either out of pocket or through insurance agencies (prescriptions, out-patient care like physiotherapy, etc).
Over the past 20-30 years, our system has seen the typical government thought process of throwing more money at problems but not actually having someone be accountable for the actions of the government over decades. You end up with a bunch of overpaid, under-worked management at the top while the actual front-line workers suffer with low staffing, not enough beds, budget cuts for the front line but raises for management etc. etc.
Not to mention the number of students coming here for health education (doctor, nurse, specialist) - then immediately saying sayonara for another country like the US or in the case of foreign students, their home country.
I don't understand why we keep cutting healthcare budgets - one possible reason could be because corporations have slowly been taking over every aspect of society as they move faster and make smarter decisions than government officials.
This is accurate. The socialized health care system in Germany worked fine for multiple decades, until a few years ago our government decided to reimburse hospitals not based on days a patient spends there (which created perverse incentives, agreed) but rather based on diagnosis. So, a hospital earns X euros for every patient with condition X, creating other perverse incentives, and resulting in less money for the hospitals, which of course trickled down to nurses.
The same happens here in Sweden. Since the implementation of more neoliberalist policies on healthcare, allowing more private clinics and paying clinics based on diagnosis created a perverse incentive to overdiagnose patients.
There was a case of a clinic that performed unnecessary surgeries and procedures just to rake in more tax money.
The problem isn't socialised medicine per se, it's trying to mash a socialised medicine system with "market forces", it's the ideology of the Third Way [1] to appease to these neoliberalist policy desires that is crumbling the Swedish healthcare (and welfare) system for the past 2 decades.
There is no easy answer to that question to my knowledge. All of what hospitals do is translated into the Dutch equivalent of diagnosis-related groups. Those DRGs are standardized across the hospitals doing procedures. Insurers bargain with hospitals (usually on a higher level) for price-setting. So while there are DRGs that probably have a large IC-component, most have only a little. So the costs of IC are reimbursed via all treatments that have an average IC-component.
A hospital with a good cost based activity system could probably tell you more, although that would require a very high measure of control.
Dutch press just reports the general direction of (internal) prices for IC-days (about € 3k / night). That really is nowhere close to the proper answer to the question "How much would expansion cost?" The sum based on that € 3k would be: €3k * 365 * 65% * 1200 = about € 850 million for the whole of IC-care. That is a low figure for the Netherlands (€ 25 billion total medical specialist care), so I expect a lot of the IC-costs are absorbed by other DRGs or the other way around: that price doesn't include all of the fixed costs and is a marginal price.
Privatization of infrastructure in Germany has always led to a, at least perceived, decline in quality. This has been true for postal service, railway, telcos and now health care.
It sounds like you read that off the government shill brochure.
The decline in public healthcare quality has nothing to do with the lack of government oversight but it's due to the lack of funding and personel (which is also funding related). Ask any overworked healthcare worker in the public system.
Diederik Grommers, one member of the Dutch Outbreak Management Team (OMG) states: "it doesn't matter if you're vaccinated or not; 60% of the beds are occupied by vaccinated people; the problems we will encounter in the coming weeks are caused by the fact that we totally hollowed out our health care" [0].
The Netherlands has about 6 ICU beds per 100.000 citizens. Germany has almost 30 ICU beds per 100.000 citizens [1]. Now I know Germany did accept patients from The Netherlands on their ICUs and perhaps Germany is doing the same for other countries, so perhaps that is causing a capacity problem in Germany as well.
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[0]: https://www.youtube.com/watch?v=yFg78PgDgu0
[1]: https://cdn.nos.nl/image/2020/03/30/640384/3840x2160a.jpg