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This article tries to explain the differences in COVID-19 case fatality rate (CFR) in 22 European countries by their type of organization and performance level of their healthcare systems. The CFR is taken here as the most important indicator since it measures the ratio between COVID deaths and COVID cases. In our view, this indicator reflects the true performance of the healthcare system, as this indicator is freed form public health interventions, like testing, lockdowns or social distancing.

Our research is also unique, because it sees the healthcare system in a holistic way and tries to explain the CFR not by individual risk factors, socioeconomic indicators, or partial system parameters, but by using a complex healthcare system classification method adopted from Isabelle Joumard and an overall healthcare system performance index adopted from European Health Consumer Index (EHCI).

The main results are twofold. First, higher EHCI score is related to lower CFR. So, the countries are cumulated basically in two quadrants: High EHCI performers (score 790 and higher) with low CFR (below 1.93%) and low EHCI performers with high COVID CFR. Second, apart from Czech Republic, the V4 countries are not doing very well in fighting COVID. Hungary is the worst, not only from the V4 group, but the worst from the whole list of 22 European countries included in this research. Poland is doing better, but still is high above the median CFR. Slovakia was the second worst from the V4 group. Czech Republic is the best V4 performer and the only country with EHCI score lower than median and CFR also lower than the median.

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