Large differences in number of hospital and intensive care beds before the pandemic

Before the onset of the pandemic, the four countries showed significant differences: In terms of hospital beds per 1,000 inhabitants, Germany had the highest value at 8.0, Spain and Israel followed with 3.0, while facilities in Denmark (2.4) and Sweden (2.1) were the lowest (values from 2018 in each case). However, the supposed advantage for patients in Germany is severely compromised by the high occupancy rate of beds and the unfavorable ratio of patients to nurses and medical staff.

A similar picture emerged for the provision of intensive care beds: Germany had by far the most intensive care beds per 100,000 inhabitants (33.9). Israel and Spain had only about a third of that (10.3 and 9.7, respectively), followed by Denmark (7.8) and Sweden (5.2).

Increasing intensive care capacity

Cacace writes in her study that all countries succeeded in rapidly increasing intensive care bed capacity (regardless of whether capacity planning was centralized, such as in Israel, or decentralized, such as in Spain). Sweden was also able to quickly reduce intensive care bed capacity when the pandemic subsided, thus saving costs. "Indispensable for this flexibility is the current availability of data on existing and built-up capacity, especially in intensive care. Sweden was the only country in our sample that had information on the number and location of intensive care beds at the onset of the pandemic," Cacace writes in the results chapter of the study. As a result, Sweden had clear advantages for expanding and contracting intensive care capacity as needed.

No data available on nursing staff in intensive care units

In addition to the number of beds, however, the number of intensive care nursing staff is also crucial for the quality of (intensive) care. The availability of (highly) qualified nursing staff is a crucial bottleneck in the adequate care of patients during the pandemic in all countries studied, Cacace writes. It is all the more astonishing that "as of today, no data are available on intensive care staff in any of the countries."

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The study was published in February and is available online free of charge at the Bertelsmann Stiftung website (in German only): Krankenhausstrukturen und Steuerung der Kapazitäten in der Corona-Pandemie. Ein Ländervergleich