Introduction

The COVID-19 pandemic exposed systemic fractures in healthcare systems across the world, highlighting disparities in how countries managed the crisis and how communities accessed care. This research proposes a comparative study of three countries, Canada (single-payer), the United States (private), and Switzerland (multi-payer), to examine how various healthcare structures affected COVID-19 management and differing responses across socioeconomic groups. The aim is to identify fundamental strengths and weaknesses, analyze the causes of inequitable care and outcomes, and develop informed, country-specific policy recommendations for future pandemic preparedness.

The project consists of two stages: a literature review assessing healthcare system effectiveness among various socioeconomic backgrounds during COVID-19 and the development of tailored policy recommendations. The six-week plan begins by defining key search terms using the MeSH database, outlining socioeconomic classes in each country, and conducting expert interviews. Subsequent weeks involve collecting and organizing health data and case studies, synthesizing findings into graphs and charts, and drawing connections between healthcare structures, policies, and outcomes. Final stages focus on a comparative analysis of both qualitative and quantitative data and the drafting of actionable policy recommendations for governmental bodies.

Framed by the guiding question of “How did the type of healthcare system affect the quality and effectiveness of COVID-19 treatment amidst socioeconomic barriers?”, this work seeks to contribute to a global network of health experts, inform future healthcare policies, and provide stronger insight into the intersection between health systems and equity in times of crisis.

Research Objectives & Questions

The primary objectives of my study are as follows:

1. Break down three prevalent healthcare systems globally through observation of three countries: Canada, Switzerland, and the United States
2. Connect socioeconomic factors to accessing healthcare facilities, workers, and treatment plans during COVID-19 in Canada, Switzerland, and the United States
3. Identify the strengths and weaknesses of each country’s healthcare system in addressing the effects of COVID-19 across their respective populations

The secondary objectives of my study are as follows:

1. Understand what socioeconomic disparities exist, which communities are most affected, and where they are located, in Canada, Switzerland, and the United States
2. Propose solutions for alternative health policies and create a framework for future pandemic readiness endeavors

Background

Globally, health systems are in disarray. This unpreparedness was exemplified during COVID-19; the sheer quantity of infected individuals caused immense strain on medical institutions, personnel, and equipment.[1] The extent of this strain, however, was felt differently on various levels. On the macro level, different types of healthcare systems affected COVID-19 policy, care, and mobilization of resources.[2] On the micro level, stark socioeconomic disparities across communities that limited access to care, vaccines, and treatment.[3] To prepare for imminent pandemics and promote health equity in crises, I propose a cross-country analysis of Canada[4], the United States[5], and Switzerland[6], looking specifically at their respective types of healthcare systems and the effect of COVID-19 on socioeconomic groups within each country.

Through this research, I aim to achieve a few goals. First, I am eager to contribute to a network of global health experts dedicated to ensuring the gold standard of care. Second, I hope to inspire my peers to pay attention to public health concerns, as the impact of COVID-19 permeated all sectors and endangered so many lives. Finally, I am interested in expanding my personal knowledge of healthcare systems, socioeconomic disparities, and the implications of health policy.

Methodology

This qualitative research project consists of two stages: a literature review on a healthcare system's effectiveness among different socioeconomic backgrounds during COVID-19 and initial policy recommendations tailored to each country's healthcare system.

Week 1 (6/16 – 6/22)

• Define key words (MeSH terms) used to search databases like PubMed, Web of Science, and Scopus (i.e., “COVID-19”, “socioeconomic”, “healthcare system”).
• Outline the various socioeconomic groups/classes within each country.
• Schedule interviews with American, Swiss, and Canadian healthcare system subject-matter experts

Week 2 (6/23 – 6/29)

• Begin the literature review process using the MeSH terms identified in Week 1, gathering resources about:
  • The American, Canadian, and Swiss healthcare systems.
  • American, Canadian, and Swiss socioeconomic groups/classes.
  • American, Canadian, and Swiss COVID-19 policies.
  • American, Canadian, and Swiss COVID-19 health data (infection rates, deaths, hospitalizations, supply shortages, etc.).
• Conduct interviews with subject-matter experts.

Week 3 (6/30 – 7/6)

• Filter the relevant content resulting from the literature review and organize the content in each category (defined in Week 2)
• Review and identify case studies from each country based on socioeconomic groups.
• Gather quantitative health data to compose relevant charts for comparative analysis.
• Conduct interviews with subject-matter experts.

Week 4 (7/7 – 7/13)

• Begin brainstorming potential policy prescriptions for each country to support future pandemic preparedness initiatives.
• Draw connections within countries’ policy efforts for comparative analysis
• Start populating quantitative health data charts.

Week 5 (7/14 – 7/20)

• Finalize quantitative health data charts from each country to include in report.
• Analyze domestic and cross-country trends in socioeconomic group, COVID-19 policies/support, and healthcare system.
• Integrate policy recommendations appropriate for each country based on their respective healthcare system.
• Begin outlining the final report

Week 6 (7/21 – 7/27)

• Focus on delivering a final report with a robust comparative analysis, comprehensive graphs/data collection, and tangible policy recommendations, while addressing the primary and secondary objectives outlined 

Potential Impact

Understanding how various healthcare systems dealt with (or failed to deal with) COVID is critical to informing future health policy planning on domestic and international levels. I hope that this research can break down the differences between private, single-payer, and mixed healthcare systems, particularly when major stressors threaten their functionality. Additionally, preventative measures can be employed to mitigate socioeconomic disparities in future disease outbreaks. Another pandemic is imminent. Learning from COVID can save money, resources, and, most importantly, lives.

Bibliography

[1] Carlo Caduff, “What Went Wrong: Corona and the World after the Full Stop,” Medical Anthropology Quarterly 34, no. 4 (July 21, 2020): 467–87, https://doi.org/10.1111/maq.12599.

[2] Arush Lal et al., “Fragmented Health Systems in COVID-19: Rectifying the Misalignment between Global Health Security and Universal Health Coverage,” The Lancet 397, no. 10268 (December 1, 2020): 61–67, https://doi.org/10.1016/s0140-6736(20)32228-5.

[3] Benjamin Wachtler et al., “Socioeconomic Inequalities and COVID-19 – A Review of the Current International Literature,” Journal of Health Monitoring 5(Suppl 7) (October 9, 2020): 3–17, https://doi.org/https://doi.org/10.25646/7059.

[4] Danielle Martin et al., “Canada’s Universal Health-Care System: Achieving Its Potential,” The Lancet 391, no. 10131 (February 23, 2018): 1718–35, https://doi.org/10.1016/s0140-6736(18)30181-8.

[5] Peter D. Donnelly et al., “Single-Payer, Multiple-Payer, and State-Based Financing of Health Care: Introduction to the Special Section,” American Journal of Public Health 109, no. 11 (October 2, 2019): 1482–83, https://doi.org/10.2105/ajph.2019.305353.

[6] Joe Cronin, “Understanding Switzerland’s Healthcare System,” International Citizens Insurance, May 10, 2024, https://www.internationalinsurance.com/health/systems/switzerland.php.