Chapter 9: Health and Social Security - Emerging European Economies after the Pandemic

Emerging European Economies after the Pandemic

                   Chapter 9: Health and Social Security
     Anikó Bíró, Zsófia Kollányi, Piotr Romaniuk, Šime Smolić, Andrej Srakar, Miha Dominko

1 Health status, healthcare and social security, 2009-2019 (15 pages,
Kollányi)
This section introduces the health status of the population and the general features of the healthcare
systems, health insurance, healthcare financing, service structure, and certain quality indicators.
For all these dimensions, we provide information relevant from three, somewhat different
perspectives. First is the baseline which gives a general overview of the state of health, healthcare
and social security at that moment COVID-19 first hit these countries. Next, we characterise the
societies from the point of view of their likely vulnerability in the case of a widespread pandemic.
Finally, the third aspect is the longer term perspective, i.e., we elaborate on the characteristics we
believe are important from the point of view of how successfully these countries can adapt to a
post-COVID-19 reality, however little we know about what this reality is going to be.
    We present the data for the investigated 8 countries topic by topic, compared to the EU (EU15,
if possible) average, and emphasising the common features and the special characteristics, if any.
We use the Eurostat database wherever it is possible, complemented by the OECD statistical
database and information drawn from the WHO Health Systems in Transition publication series.
In the case when data is not available in any these resources, we reach out for locally available
datasets.

1.1 Health status and demographic structure based on composite indicators
(4 pages)
   • Life expectancy at birth for the population as a whole and by educational attainment level
     (years)

   • Share of those aged 65 or more in 1990, 1995, 2000, 2005, 2010, 2015 and the latest data

   • Standardised mortality ratio total and by the 5 most common causes of death

   • Share of those with diabetes and high blood pressure

                                                                                                    1

1.2 Healthcare expenditure and health insurance (4 pages)
  • Total spending; Share of public financing (governmental or social health insurance),
    voluntary health insurance (VHI) and out-of-pocket (OOP) payments; per capita and
    percent of GDP

  • Health insurance coverage (population and cost dimension, with specific focus on the
    health insurance of the unemployed)

  • Size and role of private financing (VHI and OOP) - substitutive vs.
    supplementary/complementary

1.3 Structure of healthcare services (4 pages)
  • Primary care

        • No. of GPs per population

        • Age structure and lack of personnel

  • Specialized care

        • No. of specialized physician per population

        • No. of hospital beds per population

        • No. of hospital doctors per hospital beds

        • No. of nurses per hospital beds

        • No. of certain diagnostic technology per population

  • Resources in long-term care

  • The role of private sector in healthcare supply

  • E-health and telehealth

1.4 Access to care (3 pages)
  • Evidence for unmet needs (unmet needs, screening uptake, physician visits by educational
    level)

                                                                                               2

2 The impact of the COVID shock

2.1 Direct health impacts (2-3 pages, Romaniuk)
Data sources: ECDC, WHO, national statistics. Challenge: data reliability, different ways of
reporting.
    We present a concise, while comprehensive, epidemiological data regarding COVID-19 in the
analysed countries. We present overall prevalence in absolute numbers, morbidity per 100,000
population, mortality (absolute and per 100,000 population). The numbers are to be presented for
the entire population in each country and in subsequent age groups. If available, the number of
cases per number of tests performed will also be presented.
    Both the general epidemiological data, and the time flows will serve to depict the outbreak of
the pandemic in CEE, and subsequently, provide background for assessing different systemic
approaches and answers applied in different countries.
2.2 Healthcare responses (12-14 pages, Srakar, Dominko)
Data sources: Johns Hopkins University dataset, ECDC, WHO, national COVID-19 statistics,
SHARE COVID-19 Questionnaire. Challenge: frequency of data (most of the time series have to
be on daily level).
    We present an overview of policy responses including the analysis of their consequences for
important COVID-19 health variables. We include in our analysis the heterogeneity of the
responses to COVID-19 (different health and economic measures implemented, testing strategies)
across countries.
2.2.1 Descriptive analysis of policy responses

Descriptive analysis focuses on providing the information about the main parameters relevant for
the implemented measures. We focus on several key points and measures implemented: COVID-
19 testing strategies; restrictions in access to care and other related regulations; freeing up
capacities and/or creation of additional capacities; different measures in the first vs. second phase
of COVID-19.
2.2.2 Causal impacts of policy responses

The assessment of the causal impacts of policy responses on COVID-19-related health outcomes
largely follows the empirical strategy adopted by Chernozhuk et al. 2020. Due to possible problems
with the control group definition we adopt a structural equation framework similarly to this study.
To properly address heterogeneity we try to adopt the approach of Becker et al. 2013.
    The results will allow us to provide causal assessment of the effects of the main COVID-19
policy responses on health outcomes in the CEE countries.

                                                                                                   3

2.3 Indirect impacts on health and social security (6-8 pages, Bíró)

2.3.1 Health of people aged 50+

We use data from the SHARE (Survey of Health, Ageing and Retirement in Europe) COVID
survey. Data collection took place between June-August 2020 and all CEE countries participated
in it. The participants were aged 50+.
     Using these data (and for comparison, data from earlier SHARE waves), we can provide a
cross-country comparison of the impacts of the COVID crisis on physical and mental health and
healthcare use (availability), and check how these vary with the demographic and socioeconomic
background.
2.3.2 Health of the younger population

We plan to extend the analysis on the health impacts of the crisis with the analysis of the younger
population and primarily focusing on mental health. The content of the analysis will depend on the
data available early 2021. At the minimum, we can use official statistics on pharmaceutical use
(specifically of the use of antidepressants and tranquillizers) in the CEE - such up-to-date monthly
statistics are available to varying extent in Croatia and Hungary (and possibly in some other
countries as well).
2.3.3 Health insurance

Using evidence on the effect of the COVID-19 crisis on employment (possibly from Chapter 6)
and the health insurance coverage of the unemployed and those who are out of the labour force,
we will investigate to what extent the COVID-19 crisis lead potentially to a decrease in health
insurance coverage.
    We will also investigate if the COVID-19 crisis affected the health insurance systems in any
other ways (e.g., any changes in contribution rates, co-payment rates or services covered).

3 Long term prospects, conclusions (4-5 pages, Smolić)
Based on the evidence presented in Sections 1 and 2, we aim to address the following questions:
   • Did CEE countries manage to adapt their healthcare systems timely and effectively to
     COVID crisis?

   • What are the medium and the long run consequences of the healthcare system partial lock
     down?

   • Are the CEE countries now better prepared for similar shocks?

   • Did the COVID crisis reveal weak spots in CEE healthcare and social security systems,
     and how to address these challenges in the future? (Chronic problems with human
     resources in some countries; ageing of the medical profession; poor medical equipment and
     their uneven distribution).

                                                                                                  4

Policy recommendations.

Related chapters
   • Chapter 6: Labour Markets (unemployment)

         • We will need statistics on the impact of the COVID-19 shock on employment rates
           (unemployed and not in labour force) in order to provide estimates on health
           insurance status.

         • Further details will be needed if the analysis of social security should include the
           analysis of unemployment insurance.

   • Chapter 14: Inequality and Welfare.

References
Becker, J. M., Rai, A., Ringle, C. M., & Völckner, F. (2013). Discovering unobserved
heterogeneity in structural equation models to avert validity threats. MIS quarterly, 665-694.

Chernozhukov, V., Kasaha, H., & Schrimpf, P. (2020). Causal impact of masks, policies,
behavior on early COVID-19 pandemic in the US. 2020.

                                                                                                  5