Alignment and authority: Federalism, social policy, and COVID-19 response

Greer, Scott L.; Dubin, Kenneth A.; Falkenbach, Michelle; Jarman, Holly; Trump, Benjamin D.

doi:10.1016/j.healthpol.2022.11.007

Cited by 21 publications

(16 citation statements)

References 21 publications

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“…Health workforce staffing levels are among the highest in OECD countries, yet a shortage of all groups of HCWs is a serious problem and recruitment of migrant HCWs is on the increase [ 18 ]. Germany faced severe waves of COVID-19, but was less strongly hit than the neighboring countries and lockdown policies were more moderate [ 60 ].…”

Section: Resultsmentioning

confidence: 99%

“…In relation to governance, countries combined strategies at different levels. Even strongly decentralized and federalist healthcare systems mobilized national governance capacities [ 60 ]. At the same time, healthcare organizations, as well as professional associations and individual HCWs, played a major role in developing ad hoc solutions [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

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Comparing Health Workforce Policy during a Major Global Health Crisis: A Critical Conceptual Debate and International Empirical Investigation

Kuhlmann

Denis

Côté

et al. 2023

IJERPH

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Background: The health workforce is central to healthcare systems and population health, but marginal in comparative health policy. This study aims to highlight the crucial relevance of the health workforce and contribute comparative evidence to help improve the protection of healthcare workers and prevention of inequalities during a major public health crisis. Methods: Our integrated governance framework considers system, sector, organizational and socio-cultural dimensions of health workforce policy. The COVID-19 pandemic serves as the policy field and Brazil, Canada, Italy, and Germany as illustrative cases. We draw on secondary sources (literature, document analysis, public statistics, reports) and country expert information with a focus on the first COVID-19 waves until the summer of 2021. Results: Our comparative investigation illustrates the benefits of a multi-level governance approach beyond health system typologies. In the selected countries, we found similar problems and governance gaps concerning increased workplace stress, lack of mental health support, and gender and racial inequalities. Health policy across countries failed to adequately respond to the needs of HCWs, thus exacerbating inequalities during a major global health crisis. Conclusions: Comparative health workforce policy research may contribute new knowledge to improve health system resilience and population health during a crisis.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparing Health Workforce Policy during a Major Global Health Crisis: A Critical Conceptual Debate and International Empirical Investigation

Kuhlmann

Denis

Côté

et al. 2023

IJERPH

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show abstract

“…Theoretically, the research is informed by a health system approach (30), an intersectional perspective on social inequalities exacerbated by the COVID-19 pandemic, and a focus on actor-centred data (31). The connectedness of epidemiological and social conditions of the COVID-19 pandemic has been described in different ways.…”

Section: Methodsmentioning

confidence: 99%

“…A generic intersectional research framework nested in health systems and governance To begin with, our German case study reflects a health system (27) with significantly lower excess mortality than in comparable regions (30) that was relatively well prepared in terms of infrastructures and resources, spent a greater proportion of its GDP on health (11.7%) than any other EU country, and was among the OECD countries with the highest health workforce staffing levels (8,29,30,40), although workforce shortage was worsening. Further explanations for Germany's more successful pandemic management include, among others, a high amount of testing, a lower median age of those infected and the highest number of intensive care beds per 100,000 people in Europe (30). Greer and colleagues (33) furthermore highlight the importance of the governance structure and an effective allocation of authority.…”

Section: Developing An Intersectional Research Designmentioning

confidence: 99%

“…Data are especially poor for the EU region. This also raises questions about the situation in countries with a well-resourced healthcare system and hospital sector, like Germany (27, 28, 29), that managed the COVID-19 pandemic comparatively well (30). It is also not clear, how racialised discrimination reported from the UK and Brazil played out in the EU health labour market with its free movement and high cross-country mobility.…”

Section: Introductionmentioning

confidence: 99%

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Migrant healthcare workers during COVID-19: bringing an intersectional health system-related approach into pandemic protection. A German case study

Kuhlmann

Ungureanu

Behrens

et al. 2023

Preprint

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Introduction. Migrant healthcare workers played an important role during the COVID-19 pandemic, but data are lacking especially for high-resourced European healthcare systems. This study aims to research migrant healthcare workers through an intersectional health system-related approach, using Germany as a case study. Methods. An intersectional research framework was created and a rapid scoping study performed. Secondary analysis of selected items taken from two COVID-19 surveys was undertaken to compare perceptions of national and foreign-born healthcare workers, using descriptive statistics. Results. Available research is focused on worst-case pandemic scenarios of Brazil and the United Kingdom, highlighting racialised discrimination and higher risks of migrant healthcare workers. The German data did not reveal significant differences between national-born and foreign-born healthcare workers for items related to health status including SARS-CoV-2 infection and vaccination, and perception of infection risk, protective workplace measures, and government measures, but items related to social participation and work conditions with higher infection risk indicate a higher burden of migrant healthcare workers. Conclusions. COVID-19 pandemic policy must include migrant healthcare workers, but simply adding the migration status is not enough. We introduce an intersectional health systems-related approach to understand how pandemic policies create social inequalities and how the protection of migrant healthcare workers may be improved.

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Building capacity for equitable healthcare workforce policy, learning from migrant healthcare workers: A qualitative study with Romanian physicians working in Germany during COVID‐19

Kuhlmann,

Ungureanu,

Thilo

et al. 2024

Health Planning & Management

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BackgroundAttention to the healthcare workforce has increased, yet comprehensive information on migrant healthcare workers is missing. This study focuses on migrant healthcare workers' experiences and mobility patterns in the middle of a global health crisis, aiming to explore the capacity for circular migration and support effective and equitable healthcare workforce policy.MethodsRomanian physicians working in Germany during the COVID‐19 pandemic served as an empirical case study. We applied a qualitative explorative approach; interviews (n = 21) were collected from mid of September to early November 2022 and content analysis was performed.Results and DiscussionMigrant physicians showed strong resilience during the COVID‐19 crisis and rarely complained. Commitment to high professional standards and career development were major pull factors towards Germany, while perceptions of limited career choices, nepotism and corruption in Romania caused strong push mechanisms. We identified two major mobility patterns that may support circular migration policies: well‐integrated physicians with a wish to give something back to their home country, and mobile cosmopolitan physicians who flexibly balance career opportunities and personal/family interests. Health policy must establish systematic monitoring of the migrant healthcare workforce including actor‐centred approaches, support integration in destination countries as well as health system development in sending countries, and invest in evidence‐based circular migration policy.

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Alignment and authority: Federalism, social policy, and COVID-19 response

Cited by 21 publications

References 21 publications

Comparing Health Workforce Policy during a Major Global Health Crisis: A Critical Conceptual Debate and International Empirical Investigation

Comparing Health Workforce Policy during a Major Global Health Crisis: A Critical Conceptual Debate and International Empirical Investigation

Migrant healthcare workers during COVID-19: bringing an intersectional health system-related approach into pandemic protection. A German case study

Building capacity for equitable healthcare workforce policy, learning from migrant healthcare workers: A qualitative study with Romanian physicians working in Germany during COVID‐19

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