The COVID-19 pandemic has brought the subject of healthcare to the forefront. With an increasing number of cases every day, the health systems of most countries are stretched out. The healthcare workers are at the frontline in this battle against COVID-19. As such, it becomes pertinent to ask the question that why some countries are doing better than others in dealing with this crisis? Does the answer lie in the difference in the healthcare system of various countries? In this article, we try to answer this question by looking at some of the features of the healthcare systems of four countries – Taiwan, South Korea, Australia, and New Zealand – that have been successful in controlling and managing the situation.
The COVID-19 pandemic has been seen as a failure of public health leadership (Rao 2020) in several countries. It is then interesting to know and understand what countries like Taiwan, South Korea, Australia, and New Zealand have done differently from others to keep the crisis under check as much as possible.
As our analysis will show, these countries relied on their historical investment in building public healthcare and quick preparedness in dealing with the pandemic. We have identified certain features of these four countries that have had a strong impact on controlling COVID-19.
Expenditure on health
According to the latest data from the World Bank in 2017, Australia spends 9.21 per cent of its Gross Domestic Product (GDP) on health. Similarly, New Zealand spends 9.17 and South Korea 7.60 (World Bank 2017), whereas Taiwan spends around 6% of its GDP on health (Council on Foreign Relations 2020). These are strong numbers and indicate that these countries have been taking healthcare seriously even before the pandemic had struck.
Lessons from the past
After the outbreak of earlier epidemics like Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS), both Taiwan and South Korea were better prepared to handle the COVID-19 pandemic. Along with expenditure on healthcare, these countries have also worked towards building strong public healthcare systems with measures like national insurance schemes and ramped up capacity to handle large outbreaks.
Health insurance scheme
Despite being geographically close to mainland China, Taiwan has been successful in controlling the spread of the novel coronavirus, largely because of its strong public healthcare system. Article 157 of the Taiwanese constitution directs the government to implement public health provisions for all citizens. They also have a national health insurance scheme which has made providing insurance a compulsory duty of the government. The national health insurance scheme itself accounts for 3.4 per cent of the country’s GDP (Tikkanen et al 2020). The insurance scheme is electronically managed and as such the Taiwanese government had access to patient information of all its citizens. Therefore, people who tested negative earlier for COVID-19 were retested again after a few days (Tikkanen et al 2020).
While Taiwan has a heavily state reliant healthcare system, South Korea has a mixed model with equal participation from both the state and private players. Like Taiwan, South Korea too, has a national health insurance scheme which covers almost all citizens. But unlike Taiwan, a lot of healthcare services are provided by private players (Council on Foreign Relations 2020). There is thus a balance between the public and the private providers. Therefore, South Korea, too, has managed to keep the cases of the novel coronavirus under control.
Australia, too, has a mixed health model like South Korea and a universal public health insurance scheme like Taiwan that is regionally run which provides free healthcare (Tikkanen et al 2020). Despite being a large and populated region, Australia has managed to keep the number of infected patients less. As part of its well thought out response to the pandemic, the Australian government also made sure to create a balance between the public and private hospitals by moving out some health care staff and beds from the former to the latter. This was done to ease the pressure on public hospitals (Council on Foreign Relations 2020).
New Zealand also has a universal public health system that is regionally administered. The public spending on health is 78.68% of the total 9% on its GDP (Tikannen et al 2020). The country has had a relatively very low number of cases and deaths. They were able to restrict its confirmed cases to 1,504 and the deaths to 22 in the first wave (Baggaley 2020). One of the reasons behind this success was the early response from the New Zealand healthcare system. The strategy was to stamp out the virus and not contain it and deal with its consequences.
Testing measures and clear communication
Taiwan had begun testing much earlier than most countries and these tests are conducted free of cost. They were also better prepared after the 2003 outbreak of SARS (Council on Foreign Relations 2020). The country has relied on a combined strategy of a robust healthcare system, early response, and its health expertise in dealing with the pandemic. There are also daily briefings and communication to the public. As such, according to the Oxford University-based research group Our World in Data, Taiwan has recorded the lowest number of cases per million people anywhere in the world over the past 50 days or so (Khaliq 2020).
South Korea also developed effective diagnostic testing toolkits and made tests free like Taiwan. Their rate of testing, too, was very high (Council on Foreign Relations 2020). Patients with underlying illnesses who are vulnerable and at high risk were given priority (Normile 2020). Additionally, South Korea invested in Personal Protective Equipment (PPE) for its medical staff immediately after the outbreak of COVID-19 to protect them from infection. Separate physical testing spaces and kits were created for their health workers. The country has been able to keep its mortality rate to around 2% and even hold parliamentary elections (Ahn 2020). They had realized that it was essential to conduct large scale laboratory testing to contain an epidemic after their earlier experiences with SARS and MERS.
South Korea had also built a telemedicine app called Coronavirus 119 app which helped patients in inputting their symptoms like common cold or fever to get treated by a doctor on the phone. After that, it was followed up by a preliminary diagnosis and then screening (Woodward 2020). This meant that the government attempted to reach out to the maximum number of people through its healthcare system. The local and regional health structures were judiciously used to share hospital beds, medical staff and other resources.
Australia, too, conducted large scale testing and detailed contact testing of anyone who tested positive (Klein 2020). Where Australia has also done well is in involving the local health systems in fighting the COVID-19 pandemic. There have been mass screenings and extensive testing at the local district level on patients who exhibited symptoms like fever and respiratory problems. In case anybody tested positive, they were immediately quarantined.
The Australian healthcare system has also relied on geographical maps to track patients across districts to see if there were any clusters of individuals with COVID-19 like symptoms. In case anybody was found positive, these patients were provided with both medical and mental support. A COVID-19 home care service was also put in place through which health care professionals get in touch with patients in home quarantine either through the telephone or video call (Chiang 2020).
New Zealand followed a nation-wide contact testing system with around 8,000 tests per day. It is one of the highest testing rates per capita in the world (Indian Express 2020). This was complemented by effective communication from the government on the need to prioritize one’s health and implement precautionary measures.
Imposition of lockdown
Instead of enforcing full lockdowns, these countries imposed partial and phase-wise lockdowns. In South Korea, for instance, schools were closed but a total lockdown was not imposed. Taiwan had closed its borders and restricted international flights. New Zealand had a stricter lockdown as all businesses apart from essential services were shut down in April. Australia, on the other, was on partial lockdown. While many experts credit New Zealand’s isolated location and low density of population behind its success in managing the pandemic, the case of the other three countries show that with robust health systems, even in densely populated regions, the virus can be controlled.
The examples of the four countries – Taiwan, South Korea, Australia, and New Zealand – show that with a strong healthcare system in place, the COVID-19 pandemic can be managed considerably well. What is common among these countries is that they have strong public healthcare facilities and have historically invested in it.
All four countries have also carried out extensive and aggressive testing and contact testing at all levels. It is important to have a well-coordinated network of testing in place between the local and the national levels. They have also stressed on clear communication with the citizens and regular press briefings from the government. There were real-time updates about the number of people infected and in which regions to make citizens aware of the virus. All of these countries also focused on digital healthcare – be it Taiwan’s digitized insurance scheme or South Korea’s telemedicine app.
What is also interesting is the lessons that some of these countries have learned from previous epidemics. As such, they were better prepared to handle this pandemic. They also succeeded in ensuring that COVID-19 was treated only as a disease. They were more or less successful in controlling the spread of panic and the association of stigma with it. Thus, it can be said that these countries attempted to take healthcare facilities to the doorsteps of its citizens, rather than waiting for the citizens to come to them. Therefore, compared to many other wealthier nations, countries like Taiwan, South Korea, Australia, and New Zealand have been able to mitigate the first wave of the deadly novel coronavirus. At the moment, they are busy handling the second wave of COVID-19 that has already begun in many parts.
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