Health Care Systems: Organization and Response to COVID-19 with a Focus on Spain

This paper offers an overview of defining traits of national health care systems, and remarks on how to evaluate their performance in the current COVID-19 crisis. Beyond a description of the different health care provision schemes, we offer a critical review of some of the key considerations to account for in evaluating the performance of national health care systems during the pandemic. The text is organized in three parts. Part 1 provides an overview of the classification of international health care systems, and the role of the public sector in health care provision. These features condition the varying approaches taken to the pandemic and their relative effectiveness. Exploration of the particularities of the decentralized Spanish system concludes the part. Part 2 presents a snapshot of the financial situation of the systems before the impact of the pandemic. Part 3 reviews a set of factors that ought to be considered in performance evaluations of the COVID-19 response, with emphasis on the Spanish case as an illustrative example. These factors include caution in evaluating outcomes (cases, deaths), and the importance of accounting for the political and baseline demographic and socioeconomic factors that have shaped the severity of the pandemic in each country, among others.