#CoronavirusUK comparisons with Germany

The UK government efforts to deal with the Corona Virus pandemic is continually being compared with the outcomes in Germany - particularly their lower death rate.

Our government and scientific and medical advisers have received a daily barrage of questions from the media - most of it negative regarding comparisons with Germany.

The UK advisers have repeatedly said :

• Every country is different.
• Making comparisons can be miss leading because you have to be sure you are comparing like for like. What is behind the data?
• It is too early to draw emphatic conclusions about what has worked and not worked but it crucial we learn from each other as much as possible and we are in regular contact.

Most people accept this but there is a theme running through the media - both mainstream and social - that we are getting it wrong - we have been slow to respond - our leaders have been negligent and incompetent or even worse the Tories are only interested in money and don't care about the NHS and the common people.

If the purposes of objectivity I am going to focus on the point "every country is different". How does the England differ with Germany.

• Geographical size. Germany 357K sq km. England 130k sq km
• Population density Germany 240 per sq km England 430 sq km and much higher in the SE.
• Per capita income approx 15% greater in Germany. They are more wealthier than us per head of population.
• The German government debt is about 60% of GDP. The UK's is over 80%.
• Despite austerity measures our government is still spending £40 billion a year more than it has coming in (our deficit). Our debt is still going up. Germany on the other hand is in surplus and their national debt is now reducing. 

So if you want to compare our performance with Germany objectively you need to acknowledge population densities are very significantly higher in England and as a nation Germany is significantly wealthier per head of population (and therefore tax revenues are higher to spend on public services). 

(Anyone looking objectively at the state of our respective national finances will see why austerity measures were critically important in the UK.)

Another characteristic I think is the German flair for organisation. We have all observed the German tourist in operation. If you have ever been to Germany you will appreciate how organised and disciplined they are. There is no argument. The German's have a flair for getting things done and I have no doubt this has been a factor in their favour in dealing with coronavirus. In the UK it seems like the government are herding sheep. Our media has done little to help. A strand of our public are deeply cynical - bloody minded and bitterly vociferous.

And then there is a the German health care system that has apparently done so well in dealing with the coronavirus. Be careful what you wish for!

Germany has an advanced health care systems - certainly one of the oldest and best in the world on all measures. However they do not have a sacred cow - called the NHS. Their system is insurance based - is contributory based on earnings. It is multi layered. Only 50% of hospitals are state owned and there is a huge amount of private practice integrated with the state system.

I am not advocating the end of the principle of the NHS - far from it - ie free to our citizens based on need rather than ability to pay. However I do believe as the Germans have found, we would get better value for money if we were more flexible and open minded in how this vital principle is delivered. (see below) 

Healthcare in Germany is funded by a statutory contribution system that ensures free healthcare for all via health insurance funds. Insurance payments are based on a percentage of income, shared between employee and employer. 

Health insurance in Germany is divided between statutory and private schemes. The statutory health insurance, the so-called Gesetzliche Krankenversicherung(GKV), occupies a central position in the healthcare system in the Federal Republic of Germany. About 88% of the population are covered by statutory health insurance, which is compulsory for all with a gross income of less than 5,062 EUR per month. Private healthcare schemes can either provide a complete health service for those who opt out of the GKV, or top-up cover for those who remain within it.

In Germany, the provision of healthcare can be broadly separated into outpatient and inpatient sectors. Outpatient services are largely the responsibility of independent physicians practising on a freelance basis under contract to the statutory health insurer. Physicians treating patients who are members of the statutory health insurance funds must by law be registered with the regional Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung). 

Hospitals in Germany are grouped into three main types:

Public hospitals (Öffentliche Krankenhäuser) run by local authorities, towns and the Länder Voluntary, non-profit making hospitals (Frei gemeinnützige Krankenhäuser) run by churches or non-profit organisations, such as the German Red CrossPrivate hospitals (Privatkrankenhäuser) run as free commercial enterprises.

So all in all we are where we are. I trust our government and our scientific and medical advisers. They have responded to the challenge. Every nations starting point has been different. Demographics are different. Geography is different. And we are not over it yet. Let's wait and see how it works out in the end. I am very sure an objective analysis of the UK response after the event will stand up well. Lets hope so!