gms | German Medical Science

Background: The COVID-19 pandemic poses major challenges to health systems around the world. The supplied resources are becoming scarce everywhere, leading to problems in maintaining effective care in parts. Since especially older people and those with multimorbidities have been identified as at-risk groups, they are amongst those suffering most under the structural challenges, thus playing a central role in care and policy discourses.

This and other problems that emerged during the pandemic point to far-reaching structural challenges in the health system. The operational structures of health systems are at least partly determined by their funding model. Historically, two distinct mechanisms of health financing - the German system based on the foundation of Bismarck’s sickness funds, and the British NHS single-payer system developed by Beveridge - have been identified. In this study, a third model will be analysed, namely that of South Africa, a country currently in the process of developing a National Health Insurance model. This type of model has been recognised to contain aspects of both Bismarck and Beveridge models.

Objectives and research question: Based on our classification of the COVID-19 pandemic as a crisis situation (following Garfinkel 1988), the main objective of the study is to provide an ethnographic analysis that explores the structural factors that influence the quality of care provided within and across health care systems. Using primary medical and nursing care for older people in varying life situations as an example, it is the goal to identify influencing factors that are anchored within the system. These will be explored through a structured system comparison of the Beveridge System (England), the Bismarck-based system (Germany), and a system in the process of establishing a national health insurance (South Africa).

The aim is to capture the current cisis situation and its impacts, and to derive hypotheses that enable the development of a list of factors that would help to develop measures (policy) and interventions (research) appropriate to the different systems.

Methods: We aim to collect ethnographic data using a structured diary approach among the identified key groups. We will interpret the data qualitatively following the methodology of objective hermeneutics. Furthermore, we aim to capture how the situation is being experienced within each of the countries. Using an ethnographic protocol, we will describe the circumstances of social life within each country based on everyday contacts and the experience of living in the country. Researchers in all three countries will record COVID-19 related media releases from selected programmes/media outlets and analyse them using discourse analysis.

Results: The proposed presentation will argue the theoretical background and the current state of research. Furthermore, there will be results of discussion with experts of the identified key groups (patients, nurses and General Practitioners). Based on these discussions we aim to present an ethnological way to analyse the structural influences on health services quality.