A cross-country comparison of the organisation and reimbursement of intensive care in Europe

Abstract Background During the pandemic, intensive care capacity was a heavily discussed topic in Europe. Many European countries have increased their intensive care capacities to ensure treatment of all COVID-19 patients. A study, however, revealed that organisational characteristics, among other factors, were associated with in-hospital mortality. Our study thus aimed at reviewing international models for the organisation and reimbursement of intensive care. Methods Based on a scoping review, a number of European countries (Denmark, England, France, Germany, Italy, the Netherlands, Sweden) was selected for a questionnaire-based expert survey. Results In most countries, intensive care is defined by law, while the definition in two countries has a recommendatory character and/or is driven by reimbursement. In line with the European Society of Intensive Care Medicine’s recommendations, the majority of countries has organised intensive care around 2-3 different (heterogeneously defined) levels of care for which reimbursement sometimes differs according to the level. For most countries, the number of physical (i.e., number of operable beds) as well as human resources (i.e., nurses) in intensive care is unknown. Many countries have an intensive care register which, in the case of Germany, was only implemented as a response to the pandemic. However, comparability is limited due to differences in indicators used. Although promising telemedical approaches in intensive care do exist, their use is not yet formalized in most countries. Conclusions Most countries rely on a level-based organisation of intensive care, even though clear evidence on their effect is missing. Heterogeneity of definitions as well as quality monitoring makes a comparison difficult. Further research is needed to better understand best practices and thus increase resilience as well as pandemic preparedness. Telemedical interventions could elevate (access to) high-quality care, especially in times of crises. Key messages • Further research is needed to better understand best practices and thus increase resilience as well as pandemic preparedness. • Telemedicine could elevate (access to) high-quality intensive care, especially in times of crises.