11 ms·

Some key statements: "Dräger: In Europe, the number of intensive-care beds per capita is very unequally distributed. In Italy, it is three times lower than her

Some key statements: "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."

peteretep 7y ago
I’ve wondered about this for a little while. Why does Germany have five times as many ICU beds than England? Until now, I’ve never heard a suggestion that England had fewer ICU beds than it needed generally, and assuming England and Germany use beds at the same general capacity, why on earth is Germany running five times more beds that it generally needs? (please don’t answer “for a case like this” unless you have some hard evidence)
- ygra 7y ago
  As I understood it, a lot of countries have dismantled part of their hospital and healthcare infrastructure in the past 20 years (mostly to save money). Some countries have gone further than others in that pursuit. In Germany some of those measures have been decided, but not implemented yet.
- ReptileMan 7y ago
  Not saying a case like this, but don't forget that West and East Germany were supposed by the strategists to be main battlefield in eventual non nuclear WWIII ...
  - adwn 7y ago
    That is a long time ago, 30 year now. Neither the attitude nor the infrastructure from that era are still in place.
    - Zenst 7y ago
      But the legacy is still apparent.
      - guitarbill 7y ago
        that's somewhat disingenuous, taking away agency and ascribing it to other nations - some of which haven't done so great in their own coronavirus efforts. so that doesn't really make sense to me, at least not in the 21st century. 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.)
        Zenst 7y ago
        It is only disingenuous if you take it out of context from the parent I was replying too. 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.
- thu2111 7y ago
  There's some definitional problems as well. 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.
  - kmlx 7y ago
    > 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.
- tyingq 7y ago
  That doesn't surprise me culturally. I lived in Germany for a couple of years, and the deference to "rules that matter" was completely different than my US experience. Even for trivial stuff like waiting in line/queues. The Germans were much more literal in following the rules, versus my US and UK peers.
  - KingOfCoders 7y ago
    Which funnily contradicts my experience as a German in the US (interesting how cultural perception differs). I've been told in very harsh words to go in line in the US several times, once in a line for the IKEA ferry to Manhattan where I was threatened to be left behind if I do not go to the back of the line. Once in the Metropolitan museum in NYC when I skipped the ropes of an empty queue and was told to go back and follow the route through the zigzag ropes although noone was there. 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).
    - tyingq 7y ago
      Your frustration with US rules, to me, only emphasizes my point. You want the rules to work. Versus the US born/bred idea that they never will. Flippant, I know, but that's my observation. 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.
      - usrusr 7y ago
        Different cultures play loose with different rules. I believe that for every two countries, you can find one rule that exist in both but are routinely ignored in one but religiously followed in the other and another where it is exactly reversed.
    - 7y ago
- eerltjhiou 7y ago
  Basically the principles of JustInTime inventory management system applied to ICU. England optimized bed usage to be around 95%, to reduce the cost associated with empty beds.
  - pintxo 7y ago
    Germany is at 80% though. So not that much difference.
    - eerltjhiou 7y ago
      80% versus 95% occupancy while having 5 times more beds can only be explained by Germany using ICU beds when they don't really need it (ie: as regular beds).
      - liqu0rice 7y ago
        Or the UK is using regular beds where an ICU bed would be appropriate...
    - graeme 7y ago
      That’s 4x the spare capacity in the system.
      - peteretep 7y ago
        Right? It’s a bafflingly huge number, and almost everything I’ve seen mentioned so far would support 2x tops.
  - throwawaynerdy 7y ago
    You can use that mentality on things that are not safety critical. 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.
- nicoburns 7y ago
  Note that the UK spends a lot less (per capita) on healthcare than Germany: (£2,989 vs £4,432 in 2017), and that funding for healthcare has generally be considered to be insufficient over at least the last 10 years in the UK, leading to cuts in service. This may account for at least some of the difference. Source: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/articles/howdoesukhealthcarespendingcomparewithothercountries/2019-08-29 https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...
  - thu2111 7y ago
    Insufficient by what measure? You're comparing against - it appears - the second highest spender in the world. 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.
    - elyobo 7y ago
      I can't find stats to back this up either way; funding seems to have grown in real terms over time, but I can't see real funding per capita which is probably the more relevant factor.
      - pmyteh 7y ago
        It has grown in real terms, but not as fast as either demand or costs. Healthcare inflation is very high, and greatly outpaces the CPI index that we use for 'real-terms' comparisons. Basically, the same funding in 'real-terms' doesn't buy you the same level of care as last year in any country. 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.
- perlgeek 7y ago
  Queuing Theory 101: you can either optimize for usage or for availability, not for both at the same time. 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.
- MilaM 7y ago
  One explenation I heard is that hospitals in Germany perform more surgeries than any other OECD country per 100k inhabitants [1]. Not sure if it actually explains difference in the number of ICU beds. [1] https://www.gesundheitsstadt-berlin.de/oecd-studie-deutschland-bei-operationen-internationaler-spitzenreiter-1489/ https://www.gesundheitsstadt-berlin.de/oecd-studie-deutschla...
- amiga_500 7y ago
  Because the UK is _collapsing_ due to non productive rentier activity.
- freeflight 7y ago
  > why on earth is Germany running five times more beds that it generally needs? 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-storm-austerity-behind-130000-deaths-uk-ippr-report https://www.theguardian.com/politics/2019/jun/01/perfect-sto... [1] https://oec.world/en/profile/country/deu/ https://oec.world/en/profile/country/deu/ [2] https://apnews.com/ad9a6af47c3b55fd83080c9168afaaf4 https://apnews.com/ad9a6af47c3b55fd83080c9168afaaf4 [3] https://www.worldometers.info/coronavirus/#countries https://www.worldometers.info/coronavirus/#countries
  - lazyjones 7y ago
    > he 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]. 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".
    - Zenst 7y ago
      Very very true of many countries, the level of testing and how they record deaths has been done at the discretion of individual countries and in many ways, makes comparing data not as clear-cut as you would think. THough if you don't know that, you end up comparing, what are hard numbers that you take as golden and end up down many wrong turns. 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.
- usrusr 7y ago
  NHS hospitals have a completely different set of incentives than German hospitals that exist at a boundary between market capitalism and something entirely different. Terminal ICU patients are the health care equivalent of a billable hours fountain. 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.
- ajuc 7y ago
  If you ever drove a German car after driving a British car you'll understand :) The standards for "it's good enough" are vastly different in these countries.
  - amylene 7y ago
    Why do you believe that vehicle quality is related to anything else? This seems like halo effect bias.
    - ggeorgovassilis 7y ago
      The quality of a complex product is indicative of the available quality of supply chain and skill.
- ggeorgovassilis 7y ago
  Two reasons: Germany's much higher per capita income than England and it's federal structure. I won't comment on the first claim, it's self-evident. Germany is a federation of states: each state needs to provide adequate healthcare; states can't absorb spikes by distributing excessive patients to other states' hospitals (unless in a crisis) so they must over-provision infrastructure.
Zenst 7y ago
Let's add some context we can all get behind: https://en.wikipedia.org/wiki/Euro_health_consumer_index https://en.wikipedia.org/wiki/Euro_health_consumer_index
lone_post 7y ago
The US has the most ICU beds per capita among all countries. Germany is a close second. https://www.forbes.com/sites/niallmccarthy/2020/03/12/the-countries-with-the-most-critical-care-beds-per-capita-infographic/ https://www.forbes.com/sites/niallmccarthy/2020/03/12/the-co...
- lqet 7y ago
  Here is a full list: https://en.wikipedia.org/wiki/List_of_countries_by_hospital_beds 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.
- wickedwiesel 7y ago
  Is that still true? These reported numbers for the US are very much outdated. Would love to see a source younger than a decade. 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_beds#cite_note-31 https://en.wikipedia.org/wiki/List_of_countries_by_hospital_... [1] https://www.sciencemediacenter.de/alle-angebote/fact-sheet/details/news/auslastung-der-intensivstationen-zahlen-aus-deutschland-und-europa/ https://www.sciencemediacenter.de/alle-angebote/fact-sheet/d... [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4351597/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4351597/ [3] https://www.washingtonpost.com/business/2020/03/23/map-places-america-with-most-fewest-icu-beds/ https://www.washingtonpost.com/business/2020/03/23/map-place... [4] https://www-genesis.destatis.de/genesis//online?operation=table&code=12411-0005&levelindex=0&levelid=1585406327695 https://www-genesis.destatis.de/genesis//online?operation=ta...
- dalai 7y ago
kyrra 7y ago
The US last got data in 2010 I believe. I believe this is the paper many people site today: https://www.cambridge.org/core/journals/disaster-medicine-and-public-health-preparedness/article/mechanical-ventilators-in-us-acute-care-hospitals/F1FDBACA53531F2A150D6AD8E96F144D 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-dividend-11584399701 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=article_inline https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551445/?mod=ar...
- wickedwiesel 7y ago
  Since I looked around a lot for newer numbers, I thought I'd point out some newer numbers in my reply to the sibling comment [0]. 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. [0] - https://news.ycombinator.com/item?id=22711215 https://news.ycombinator.com/item?id=22711215
InTheArena 7y ago
By reporting, I suspect he means testing, as the actual reporting is working as expected. As for testing the United States did 120k tests yesterday and is accelerating. The CDC test failing really set things back. 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).
- koheripbal 7y ago
  While it is true that testing in the US is lacking - that is true of many countries - particularly in more rural areas. I've seen estimates everywhere between 90 to 99.9% of cases going untested.
  - InTheArena 7y ago
    Yes, and honestly, testing makes it easier to constrain (at first) and see something much closer to the true CFR.
- kyrra 7y ago
  By reporting, I believe they mean how many ventilators the US has. See my peer comment to yours that has data from 2010 and 2012, which is the newest the US seems to have.

peteretep 7y ago

I’ve wondered about this for a little while. Why does Germany have five times as many ICU beds than England? Until now, I’ve never heard a suggestion that England had fewer ICU beds than it needed generally, and assuming England and Germany use beds at the same general capacity, why on earth is Germany running five times more beds that it generally needs? (please don’t answer “for a case like this” unless you have some hard evidence)

ygra 7y ago
As I understood it, a lot of countries have dismantled part of their hospital and healthcare infrastructure in the past 20 years (mostly to save money). Some countries have gone further than others in that pursuit. In Germany some of those measures have been decided, but not implemented yet.
ReptileMan 7y ago
Not saying a case like this, but don't forget that West and East Germany were supposed by the strategists to be main battlefield in eventual non nuclear WWIII ...
- adwn 7y ago
  That is a long time ago, 30 year now. Neither the attitude nor the infrastructure from that era are still in place.
  - Zenst 7y ago
    But the legacy is still apparent.
    - guitarbill 7y ago
      that's somewhat disingenuous, taking away agency and ascribing it to other nations - some of which haven't done so great in their own coronavirus efforts. so that doesn't really make sense to me, at least not in the 21st century. 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.)
      - Zenst 7y ago
        It is only disingenuous if you take it out of context from the parent I was replying too. 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.
thu2111 7y ago
There's some definitional problems as well. 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.
- kmlx 7y ago
  > 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.
tyingq 7y ago
That doesn't surprise me culturally. I lived in Germany for a couple of years, and the deference to "rules that matter" was completely different than my US experience. Even for trivial stuff like waiting in line/queues. The Germans were much more literal in following the rules, versus my US and UK peers.
- KingOfCoders 7y ago
  Which funnily contradicts my experience as a German in the US (interesting how cultural perception differs). I've been told in very harsh words to go in line in the US several times, once in a line for the IKEA ferry to Manhattan where I was threatened to be left behind if I do not go to the back of the line. Once in the Metropolitan museum in NYC when I skipped the ropes of an empty queue and was told to go back and follow the route through the zigzag ropes although noone was there. 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).
  - tyingq 7y ago
    Your frustration with US rules, to me, only emphasizes my point. You want the rules to work. Versus the US born/bred idea that they never will. Flippant, I know, but that's my observation. 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.
    - usrusr 7y ago
      Different cultures play loose with different rules. I believe that for every two countries, you can find one rule that exist in both but are routinely ignored in one but religiously followed in the other and another where it is exactly reversed.
  - 7y ago
eerltjhiou 7y ago
Basically the principles of JustInTime inventory management system applied to ICU. England optimized bed usage to be around 95%, to reduce the cost associated with empty beds.
- pintxo 7y ago
  Germany is at 80% though. So not that much difference.
  - eerltjhiou 7y ago
    80% versus 95% occupancy while having 5 times more beds can only be explained by Germany using ICU beds when they don't really need it (ie: as regular beds).
    - liqu0rice 7y ago
      Or the UK is using regular beds where an ICU bed would be appropriate...
  - graeme 7y ago
    That’s 4x the spare capacity in the system.
    - peteretep 7y ago
      Right? It’s a bafflingly huge number, and almost everything I’ve seen mentioned so far would support 2x tops.
- throwawaynerdy 7y ago
  You can use that mentality on things that are not safety critical. 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.
nicoburns 7y ago
Note that the UK spends a lot less (per capita) on healthcare than Germany: (£2,989 vs £4,432 in 2017), and that funding for healthcare has generally be considered to be insufficient over at least the last 10 years in the UK, leading to cuts in service. This may account for at least some of the difference. Source: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/articles/howdoesukhealthcarespendingcomparewithothercountries/2019-08-29 https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...
- thu2111 7y ago
  Insufficient by what measure? You're comparing against - it appears - the second highest spender in the world. 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.
  - elyobo 7y ago
    I can't find stats to back this up either way; funding seems to have grown in real terms over time, but I can't see real funding per capita which is probably the more relevant factor.
    - pmyteh 7y ago
      It has grown in real terms, but not as fast as either demand or costs. Healthcare inflation is very high, and greatly outpaces the CPI index that we use for 'real-terms' comparisons. Basically, the same funding in 'real-terms' doesn't buy you the same level of care as last year in any country. 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.
perlgeek 7y ago
Queuing Theory 101: you can either optimize for usage or for availability, not for both at the same time. 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.
MilaM 7y ago
One explenation I heard is that hospitals in Germany perform more surgeries than any other OECD country per 100k inhabitants [1]. Not sure if it actually explains difference in the number of ICU beds. [1] https://www.gesundheitsstadt-berlin.de/oecd-studie-deutschland-bei-operationen-internationaler-spitzenreiter-1489/ https://www.gesundheitsstadt-berlin.de/oecd-studie-deutschla...
amiga_500 7y ago
Because the UK is _collapsing_ due to non productive rentier activity.
freeflight 7y ago
> why on earth is Germany running five times more beds that it generally needs? 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-storm-austerity-behind-130000-deaths-uk-ippr-report https://www.theguardian.com/politics/2019/jun/01/perfect-sto... [1] https://oec.world/en/profile/country/deu/ https://oec.world/en/profile/country/deu/ [2] https://apnews.com/ad9a6af47c3b55fd83080c9168afaaf4 https://apnews.com/ad9a6af47c3b55fd83080c9168afaaf4 [3] https://www.worldometers.info/coronavirus/#countries https://www.worldometers.info/coronavirus/#countries
- lazyjones 7y ago
  > he 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]. 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".
  - Zenst 7y ago
    Very very true of many countries, the level of testing and how they record deaths has been done at the discretion of individual countries and in many ways, makes comparing data not as clear-cut as you would think. THough if you don't know that, you end up comparing, what are hard numbers that you take as golden and end up down many wrong turns. 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.
usrusr 7y ago
NHS hospitals have a completely different set of incentives than German hospitals that exist at a boundary between market capitalism and something entirely different. Terminal ICU patients are the health care equivalent of a billable hours fountain. 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.
ajuc 7y ago
If you ever drove a German car after driving a British car you'll understand :) The standards for "it's good enough" are vastly different in these countries.
- amylene 7y ago
  Why do you believe that vehicle quality is related to anything else? This seems like halo effect bias.
  - ggeorgovassilis 7y ago
    The quality of a complex product is indicative of the available quality of supply chain and skill.
ggeorgovassilis 7y ago
Two reasons: Germany's much higher per capita income than England and it's federal structure. I won't comment on the first claim, it's self-evident. Germany is a federation of states: each state needs to provide adequate healthcare; states can't absorb spikes by distributing excessive patients to other states' hospitals (unless in a crisis) so they must over-provision infrastructure.

Zenst 7y ago

Let's add some context we can all get behind: https://en.wikipedia.org/wiki/Euro_health_consumer_index https://en.wikipedia.org/wiki/Euro_health_consumer_index

lone_post 7y ago

The US has the most ICU beds per capita among all countries. Germany is a close second. https://www.forbes.com/sites/niallmccarthy/2020/03/12/the-countries-with-the-most-critical-care-beds-per-capita-infographic/ https://www.forbes.com/sites/niallmccarthy/2020/03/12/the-co...

lqet 7y ago
Here is a full list: https://en.wikipedia.org/wiki/List_of_countries_by_hospital_beds 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.
wickedwiesel 7y ago
Is that still true? These reported numbers for the US are very much outdated. Would love to see a source younger than a decade. 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_beds#cite_note-31 https://en.wikipedia.org/wiki/List_of_countries_by_hospital_... [1] https://www.sciencemediacenter.de/alle-angebote/fact-sheet/details/news/auslastung-der-intensivstationen-zahlen-aus-deutschland-und-europa/ https://www.sciencemediacenter.de/alle-angebote/fact-sheet/d... [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4351597/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4351597/ [3] https://www.washingtonpost.com/business/2020/03/23/map-places-america-with-most-fewest-icu-beds/ https://www.washingtonpost.com/business/2020/03/23/map-place... [4] https://www-genesis.destatis.de/genesis//online?operation=table&code=12411-0005&levelindex=0&levelid=1585406327695 https://www-genesis.destatis.de/genesis//online?operation=ta...
dalai 7y ago

kyrra 7y ago

The US last got data in 2010 I believe. I believe this is the paper many people site today: https://www.cambridge.org/core/journals/disaster-medicine-and-public-health-preparedness/article/mechanical-ventilators-in-us-acute-care-hospitals/F1FDBACA53531F2A150D6AD8E96F144D 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-dividend-11584399701 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=article_inline https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551445/?mod=ar...

wickedwiesel 7y ago
Since I looked around a lot for newer numbers, I thought I'd point out some newer numbers in my reply to the sibling comment [0]. 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. [0] - https://news.ycombinator.com/item?id=22711215 https://news.ycombinator.com/item?id=22711215

InTheArena 7y ago

By reporting, I suspect he means testing, as the actual reporting is working as expected. As for testing the United States did 120k tests yesterday and is accelerating. The CDC test failing really set things back. 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).

koheripbal 7y ago
While it is true that testing in the US is lacking - that is true of many countries - particularly in more rural areas. I've seen estimates everywhere between 90 to 99.9% of cases going untested.
- InTheArena 7y ago
  Yes, and honestly, testing makes it easier to constrain (at first) and see something much closer to the true CFR.
kyrra 7y ago
By reporting, I believe they mean how many ventilators the US has. See my peer comment to yours that has data from 2010 and 2012, which is the newest the US seems to have.