The pandemic has highlighted problems that have plagued U.S. healthcare for decades.
The coronavirus disease 2019 (COVID-19) pandemic has four monumental implications for U.S. healthcare, a recent journal article says.
The COVID-19 pandemic poses the greatest public health threat in the United States since the Spanish flu outbreak a century ago. As of Aug. 4, more than 4.8 million Americans had been infected with the novel coronavirus and 159,000 had died, according to worldometer.
The recent journal article, which was published by the New England Journal of Medicine, says the COVID-19 pandemic has laid bare fundamental weaknesses in U.S. healthcare.
"The novel coronavirus pandemic has spawned four intertwined healthcare crises that reveal and compound deep underlying problems in the healthcare system of the United States. In so doing, however, the pandemic points the way toward reforms that could improve our ability not only to cope with likely future epidemics but also to serve the basic healthcare needs of Americans," the journal article co-authors wrote.
1. Health insurance crisis
The economic calamity associated with the COVID-19 pandemic has dealt a devasting blow to employer-sponsored insurance.
More than 20 million Americans have lost their jobs since the COVID-19 pandemic upended society in March. The spike in unemployment is likely to prompt millions of Americans to lose their employer-sponsored insurance. A recent Commonwealth Fund survey found that 40% of respondents or their partner who were laid off or furloughed had employer-sponsored insurance.
The pandemic-induced healthcare coverage mess is an opportunity to build on the coverage gains achieved through the 2010 Patient Protection and Affordable Care Act, the journal article co-authors wrote. "Proponents of expanded coverage have multiple policy options to choose from, ranging from a government-financed single-payer system such as Medicare for All to reforms that build on current law."
2. Healthcare provider financial crisis
The COVID-19 pandemic has wreaked calamitous financial losses at hospitals and physician practices. "Office-based practices had reductions of 60% in visit volumes in the first months of the crisis, and, by their own estimates, hospitals will lose an estimated $323.1 billion in 2020," the journal article co-authors wrote.
There are two primary solutions for the healthcare provider financial crisis, they wrote.
- Shifting away from the fee-for-service model of healthcare payment to a capitation model. "One advantage of full or partial capitation and prospective budgeting is that they offer hospitals and health professionals a predictable stream of revenue that is unlinked from the volume of services provided. Capitation would have protected many providers against the sharp short-term losses they are sustaining as a result of COVID-19," the journal article co-authors wrote.
- Boosting resources for services that have not been well-financed under the fee-for-service model such as primary care, behavioral health, and rural healthcare.
3. Healthcare disparity crisis
The coronavirus pandemic has exposed racial and ethnic disparities in U.S. healthcare, the journal article co-authors wrote. "Black persons constitute 13% of the U.S. population but account for 20% of COVID-19 cases and more than 22% of COVID-19 deaths, as of July 22, 2020. Hispanic persons, at 18% of the population, account for almost 33% of new cases nationwide."
There are five primary ways healthcare disparities can be address, they wrote.
- Broad societal action could be taken to improve the social determinants of health problems that beset communities of color such as substandard education and food insecurity.
- Establishing universal healthcare coverage would improve access to care for racial and ethnic groups, which would help reduce the incidence of chronic conditions in these populations.
- Boosting resources for safety-net hospitals and small community healthcare facilities also would improve access to healthcare services.
- Anti-bias training could be mandatory in the education and licensing of healthcare workers.
- Medicare and Medicaid payments could be tied to quality of care metrics for healthcare services provided to communities of color.
4. Public health crisis
Compared to other countries, the United States has been the hardest hit during the COVID-19 pandemic, uncovering weaknesses in the American public health system.
"Put simply, that system failed to quickly identify and control the spread of the novel coronavirus. The United States did not make testing widely available early in the pandemic, was late to impose physical-distancing guidelines, and has still not implemented either as widely as needed. National guidance on managing the pandemic has been inconsistent and delayed. Many states have now abandoned stringent physical-distancing guidelines without careful attention to public health measures needed to prevent resurgence," the journal article co-authors wrote.
There are five primary actions to improve the public health system, they wrote.
- The country needs to strengthen its ability to implement collective public health measures such as bolstering state and local public health authorities.
- During a public health emergency, federal authorities should have the ability to spend taxpayer dollars without congressional approval.
- During a pandemic, the federal government should be able to mandate state efforts to control the spread of infection.
- During a pandemic, the federal government should be able to manage the distribution of vaccines and antimicrobial agents.
- During a public health emergency, the federal government should be able to compel states to allow clinicians to provide interstate telehealth services.
Christopher Cheney is the senior clinical care editor at HealthLeaders.
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