COVID-19 will leave a permanent mark on health care

By Alex Branch

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The COVID-19 pandemic could cause lasting fundamental changes to the U.S. health care system, including how and where patients receive care, said an HSC Fort Worth expert in Health Behavior and Health Systems.

“Unlike some countries, we have not experienced a hard reset of our healthcare system,” said Thaddeus Miller, PhD, Associate Professor in the School of Public Health. “When that happens, it’s usually only because you are forced to do it. This may force us to do it.”

The final result of those changes is still as uncertain as the novel coronavirus itself. Health providers, hospitals, insurers and health regulators are scrambling to navigate the crisis.

Small practices already feel the economic impact of patients no longer coming in for routine seasonal illnesses. Medicaid will likely soon feel the strain of millions of Americans losing health benefits as they lose their jobs. Health services are being provided in nontraditional settings like drive-through test sites.

Meanwhile, long-standing rules have changed to give the healthcare system flexibility, allowing hospitals to provide care outside its walls, letting resident doctors perform more duties and eliminating some paperwork requirements so providers can spend more time with patients.

“The health care industry, like any other industry, is adapting to COVID-19,” Dr. Miller said. “Just like in other industries, some of the effects and innovations will probably become permanent.”

Virtual-care services – providers and patients interacting by webcam, for example – has flourished as patients are encouraged to stay home and not visit doctor’s offices. One previous drawback to virtual care was that it was often more difficult for providers to get reimbursed for the care they provide.

“Once people get used to something, it’s hard to take it away,” Dr. Miller said. “Some changes to reimbursements have already been for virtual care due to COVID-19, but making it work long-term for the patient and provider will probably be necessary.”

Changes in patient behavior, however, could alter the landscape of smaller, physician-owned practices. Without patients coming in for non-emergent illnesses and with prohibitions on many elective procedures, business has plummeted.

“A small physician’s office operates essentially like any small business – last month’s appointments are this month’s cash flow,” Dr. Miller said. “Patients are no longer coming in to be seen for routine illnesses. If you are a big practice with deep pockets, you’ll make it. A small practice might not.”

Changes in behavioral determinants for health could make us better off from a population health perspective. People eating healthy home-cooked meals, taking family walks and commuting less during social distancing might realize they feel great.

“My family, for example, hasn’t darkened the door of a fast food restaurant in weeks,” Dr. Miller said. “We’re cooking at home and taking walks together. Most of us are probably healthier now than we were two or three weeks ago.”

The long-term health repercussions for survivors of COVID-19 are not yet known but could have a significant impact on the health care system. Studies of survivors of the SARS pandemic, which infected about 8,000 people in 2002 and 2003 and shares similarities with the novel coronavirus behind COVID-19, found that many of them experienced long-term health effects.

There are already almost 1 million confirmed cases of COVID-19 worldwide and that figure will continue to soar. If the disease leaves survivors with long-term respiratory problems or other ill effects, the healthcare system would have to adjust for that.

“I was telling my 17-year-old daughter recently that she will remember a ‘before’ COVID-19 and an ‘after” COVID-19,” Dr. Miller said. “Good or bad, changes are coming. Healthcare is no different.”

 

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