5 ms·

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 do

by wsc981 5y ago

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. --- [0]: https://www.youtube.com/watch?v=yFg78PgDgu0 https://www.youtube.com/watch?v=yFg78PgDgu0 [1]: https://cdn.nos.nl/image/2020/03/30/640384/3840x2160a.jpg https://cdn.nos.nl/image/2020/03/30/640384/3840x2160a.jpg

nzk 5y ago
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: https://www.intensivregister.de/#/aktuelle-lage/zeitreihen https://www.intensivregister.de/#/aktuelle-lage/zeitreihen 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 :)
- wsc981 5y ago
  > 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.
- i_don_t_know 5y ago
  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.
ChuckNorris89 5y ago
>"[...] we totally hollowed out our health care" Weird move for one of the richest countries in the world, no?
- emsy 5y ago
  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.
  - ChuckNorris89 5y ago
    Except he was talking about the Netherlands.
  - odiroot 5y ago
    Health care in Germany is a not-for-profit endeavour and is strictly controlled by the law, with ministry of health oversight.
    - ChuckNorris89 5y ago
      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.
      - mensetmanusman 5y ago
        It’s a lack of personnel because the population pyramid is going from a triangle to a rectangle. This is what that transition does to the labor force.
    - mandmandam 5y ago
      People are dying friendo, please wise up.
  - 5y ago
wjnc 5y ago
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.
- Auracle 5y ago
  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.
  - scohesc 5y ago
    > 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.

by wsc981 5y ago

nzk 5y ago

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: https://www.intensivregister.de/#/aktuelle-lage/zeitreihen https://www.intensivregister.de/#/aktuelle-lage/zeitreihen 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 :)

wsc981 5y ago
> 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.
i_don_t_know 5y ago
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.

ChuckNorris89 5y ago

>"[...] we totally hollowed out our health care" Weird move for one of the richest countries in the world, no?

emsy 5y ago
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.
- ChuckNorris89 5y ago
  Except he was talking about the Netherlands.
- odiroot 5y ago
  Health care in Germany is a not-for-profit endeavour and is strictly controlled by the law, with ministry of health oversight.
  - ChuckNorris89 5y ago
    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.
    - mensetmanusman 5y ago
      It’s a lack of personnel because the population pyramid is going from a triangle to a rectangle. This is what that transition does to the labor force.
  - mandmandam 5y ago
    People are dying friendo, please wise up.
- 5y ago

wjnc 5y ago

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.

Auracle 5y ago
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.
- scohesc 5y ago
  > 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.