In January 2020, the first European COVID-19 patient was hospitalized. One year later the pandemic is still raging with major professional and personal implications.

Health Commissioner Stella Kyriakides considers that we are now only midway through the crisis. Private Hospitals are fully committed to continue fighting the pandemic and limiting its dramatic consequences for the affected people.

The COVID-19 pandemic has had and will continue to have very considerable effects on the physical and mental well-being of people around the world. As human beings we must find physical and psychological stability. Mental health protection is indeed also a priority.

Vaccination is our new hope for a lasting way out of the pandemic, but vaccination is also a new challenge. This is a massive initiative which will require the involvement of all, private hospitals included.

The private hospital sector supports all European efforts to diffuse the vaccine for all European citizens and health professionals. All forces must converge towards the same goal: limit harm and eradicate the pandemic and its consequences.

The future of EU27 depends on a global strategy. The COVID-19 pandemic has awoken the need for One Health collaboration. The One Health European concept to protect the health of all.
In hard times, our priority is to protect people, but we must also look ahead and try to contribute positively to a new paradigm of positive European solutions in sustainable healthcare.

AUSTRIA

In the case of private healthcare companies, employees are vaccinated, and in the case of nursing homes and Covid stations in the private sector, both employees and patients/residents are vaccinated. This has been and is still being implemented as part of Phase 1 of the national vaccination plan. To date, private hospitals have not acted as official vaccination sites for the rest of the population.

In principle, in Austria, the private hospital workforce is treated the same as public hospitals and is scheduled for vaccination on the same schedule. Locally, however, there could be de facto differences in the timing of vaccination due to possible shortages of or delays in delivery of the vaccine. But so far no unequal treatment could be found.

FRANCE

The private hospitalisation is fully committed to this vaccination campaign. As of 13 January, 40 private establishments had opened a vaccination center for the population, via the public hospital network. 150 additional centers in private hospitals will progressively open as the vaccination campaign gets underway. Private hospitals were entitled to vaccinate their own staff at the beginning of January.

The vaccination campaign started at the end of Dezember with elderly people residing in care homes, where both residents and carers over 50 have been vaccinated. Since January, health professionals over the age of 50 or presenting a risk factor of developing severe forms of Covid-19 have been prioritised, then all health professionals and sanitary workers in phase three, regardless of the ownership of their health establishment.

GERMANY

Hospitals in Germany are actively involved in the implementation of the vaccination strategy, regardless of their status. Hospitals under private sponsorship are aware of their special responsibility in this regard and take it seriously as a matter of course. For the organisation and implementation of Covid-19 vaccination, a national vaccination strategy was developed by the Federal Ministry of Health in cooperation with the Robert Koch Institute, the Paul Ehrlich Institute and the Federal Centre for Health Education. It provides for a multi-phase model. In phases I and II, vulnerable and exposed population groups receive the Covid 19 vaccination.

For hospitals in Germany - whether public, non-profit or private - the vaccination of staff is currently a top priority. Hospital staff working in isolation or intensive care units, in emergency rooms and with particularly vulnerable patients in oncology or transplantation medicine can currently be vaccinated against Covid-19 in the so-called phase I. The current extent and pace of vaccination is difficult to assess, as there are strong regional differences with regard to the provision of the vaccine. The sponsorship of the individual hospitals does not play a role in this regard.

GREECE

The Greek government officially designated all members of the Hellenic Private Hospital Association (HPHA) as Covid-19 vaccination centers, for their employees, doctors and external service providers such as catering, security, housekeeping, etc.

All hospitals of HPHA were asked to provide detailed lists of people to be vaccinated, including social security numbers, to the Ministry of Health. Thus, the Ministry had an accurate count of the doses required in each vaccination site, and generated approved lists of inoculations. The training of our physicians and pharmacists took place on January 10th at assigned public hospitals, and additional online training was provided on January 11th. The vaccines and the tablets for registration were delivered to our respective facilities in the morning on January 12th. The vaccination started a few hours later.

We were allowed to vaccinate personnel from other member hospitals if there were some doses left in one hospital and a lack of doses in an other. It seems plausible that at a later stage we may be allowed to vaccinate patients in oncology, dialysis, and other special groups of patients that receive services at our facilities. We are not designated vaccination centers for the general population, as this would be a logistics nightmare. Today, January 13th, the vaccinations continue in a smooth way but faster than scheduled.

ITALY

In Italy, healthcare workers have been put at the front of the queue for Covid vaccine, so that healthcare professionals working in private hospitals can also be vaccinated. At present, private hospitals are preparing to administer the vaccine to their inpatients in long care and get ready to cooperate in the vaccination of the population.

In Sicily private and public hospitals have been involved from the Health Department to take part in the vaccination of their employees and collaborators. It organised webinars on how to prepare and inoculate the vaccine, provided us with doses and we have then been able to administer the vaccine to our own staff.

MONACO

The private healthcare facilities of the Principality of Monaco do not participate directly in the vaccination of the population but our staff - practitioners and nurses - intervene on a voluntary basis in the structure set up by the Principality to ensure this vaccination.

The Prince's Government has structured the vaccination of the population by prioritizing, first of all, people over the age of 75, then those over 65 and at the same time healthcare staff from both the public and private sectors and city.

We have just completed the vaccination of our volunteer employees and are going to carry out the second injection phases.

POLAND

In Poland, health carers working in the public and private sectors have been vaccinated since the end of December in designated public hospitals. From January 15th, citizens of the 85+ age group are vaccinated in public hospitals and private clinics, followed by the next age group, etc.

PORTUGAL

Private hospitals declared to the Ministry that they were available for the vaccination of the population, but the Ministry of Health did not answer.

Health professionals (doctors, nurses and assistants) of private hospitals were included in the national plan but the vaccination did not start at the same time. Employees from the public sector and other groups such as elderly people in institutions have been vaccinated since December 27th whereas the vaccination campaign for carers from the private sector only started on January 14th.

The first phase prioritized following professionals:

• Oral health / dental medicine services
• Professionals involved in providing home care
• Intensive and intermediate care units
• Emergency services
• Inpatient services dedicated to Covid-19 patients
• Dialysis units
• Neonatology Units
• Respiratory and gastroenterology units
• Otorhinolaryngology services
• Anesthesiology services
• Professionals involved in collecting and handling respiratory samples for the diagnosis of SARS-CoV-2 infection
• Operating rooms

ROMANIA

The private sector in Romania has been involved in the vaccination process, mainly for our employees, but in some regions also for the general population.
The private sector could decide whether or not to organize vaccination centers both for the vaccination of its own staff and for other categories of the population depending on the vaccination stage and the priorities established in the national vaccination strategy. In the national vaccination plan, private sector employees have the same rights and obligations as public sector employees.

SPAIN

In Spain, only the Autonomous Communities of Madrid, Catalonia and Murcia currently have private health centers in their territories to speed up the Covid-19 vaccination strategy. The Catalan Government has recently verified that it will rely on private healthcare, at least through subsidized centers.
However, at ASPE (Spanish Private Hospital Association) we continue to defend the complementarity of public and private health as a key management tool of the National Health System, which will guarantee the vaccination of the Spanish population in the shortest possible time. We are a highly qualified, professional and technical, efficient and well-organized sector capable of assuming a relevant role in the largest vaccination campaign in our history, and we offer our infrastructure to contribute to the health of all Spaniards.

Last week, ASPE denounced the existence of regions which had not the intention to include Health workers from the private sector into the preferential risk groups defined in the Ministry of Health's "COVID-19 Vaccination Strategy". In this way, the decisions communicated by Galicia, the Valencian Community and the Canary Islands presented an unjustified and obvious risk factor for the healthcare professionals and their patients. The Autonomous Communities that have requested data about the health professionals from the private sector to be included in their vaccination plan (Madrid, Murcia, Balearic Islands, Andalusia, La Rioja, Navarra and Catalonia), are now joined by Valencia, the Canary Islands, the Basque Country and Galicia. In this context, finally, all the autonomous communities have confirmed that there will be no discrimination in the supply of vaccines against Covid-19 towards health professionals from the private health sector.

SWITZERLAND

The federal government has mandated the army to distribute the vaccines to each Canton and each Canton is mandated to organize the actual vaccinations to the population. The vaccines are free for the population and are paid for by contributions from the federal and cantonal governments and the mandatory health insurance companies. Private hospitals have been involved in the fight against the pandemic and some are operating Covid-19 vaccination centers now. The Hirslanden group for instance has been entrusted to operate vaccination centers in four cantons already.

We have not seen a difference in providing priority vaccinations to healthcare workers in the public vs the private sector. As each Canton organizes the actual administration we can't exclude possible discriminatory practices but we believe that they will be very limited.

What is the fundamental role of the National Union of Private Health Establishments in Medicine, Surgery, Obstetrics, of which you have assumed the presidency?

To defend each private healthcare establishment, to collectively defend our standing in the French healthcare arena, and to capitalize on this new positioning. Next, our great challenge is to simplify the administrative context in which we work. Our Ministry has a visceral need to create laws and regulations, whose actors on the ground understand neither the stakes nor the interest. The administration is self-feeding in a closed circuit. A misunderstanding shared by the public hospital as well. Our strength is our responsiveness but managing the very complex administrative environment imposed on us requires a huge amount of energy that does not benefit the patient.

The French hospital system rests on three pillars, a public, private non-profit and private sector that takes care of approximately 30% of patients. What are the strengths of this "French " system?

The first strength is that no sector has a monopoly, which anyway is never an advantage for the consumer. When a company has a monopoly on a service or a product, why would it be worried about winning the market? Having a relatively strong private hospital sector facing public hospitals, which are by definition strong, is an opportunity for the patient. Allowing them to choose their health care institution creates de facto a healthy competition between the players.

However, our weakness with regard to the patient is the excess cost (even if it is a modest sum), which after reimbursement from the National Health Insurance and complementary insurances, remains to be paid by the patient at the end of his stay - except for emergency care, which is totally free of charge for all. Therefore, we have the obligation to offer exemplary care to the users who trust us and give them an above-average service. All private hospitals are under agreement with the National Health Insurance and the State (except the American Hospital in Paris). The rates charged are set by the State, and we are only allowed to set our own prices for extra services (private room, catering, etc.). The doctors who practice in our clinics have a liberal status and are hospital employees only in very rare cases. Their rates are also set by the State, but a large part of the practitioners are free to charge additional fees.
For the State, having private hospital facilities that are less expensive to the National Health Insurance is an advantage, as the latter would be unable to assume the additional cost of financing care if it were carried out exclusively in public hospitals, at public hospital prices. Although the regulations, training, etc. are strictly identical, the 20% extra cost of the public hospital sector remains unexplained.

During the crisis, the French hospital system demonstrated its resilience, but the public hospital sector also demonstrated that it could not have faced the epidemic alone. Our private sector showed its extreme responsiveness everywhere in France. We adapted in 24 hours to meet the needs of Covid patients such as those in intensive care, or lately this month for vaccination. The proof of this is that the Minister of Health has acceded to our requests for additional funding for the care of Covid patients and has included us in the revaluation of the salaries of our professionals within the framework of the Ségur de la santé agreement (new social security law adopted last summer). In my opinion, and with the current crisis, this is the first time that the place of private hospitals has been recognized to such an extent. Likewise, the population saw that we could achieve important things...as well as the regional health agencies (regional branch offices of the Ministry of Health)!