Given the health care system’s current inability to properly address the coronavirus disease 2019 (COVID-19) pandemic, it is fair to wonder how much other important healthcare will be neglected during the outbreak. We might also wonder what additional negative impact this will have on Americans’ health status.
Regarding virtual care, the reality is we are simply nowhere close to having the technology or expertise to do it right, regardless of payment being available. In addition, some health care professional still has to be involved in telehealth provision, so in a system with no capacity it is hard to imagine telehealth making much short-term difference.
There is no doubt that our health system must gear up first and foremost for the crisis at hand. The need to keep people at home and away from public spaces is a short-term imperative to blunting the spread of COVID-2019. But over the longer term, if we make patients significantly delay or cancel the important care they require to stay healthy and function independently, or provide it in a low-quality way, we risk making the effects of this pandemic much worse.
Blood sugars and high blood pressure that cannot be monitored or controlled properly; unperformed surgical procedures that enhance patients’ ability to care for themselves or others; mental health issues that impact people’s ability to think and behave proactively with respect to staying healthy, and being able to work and earn a paycheck—left neglected, these realities will amplify how COVID-19 affects local populations. They will also leave many more Americans in worse health once the pandemic is over.
There are no easy solutions to these problems. The greater number of nations, including Italy, the United States, and the United Kingdom have spent years underinvesting in primary care systems. Here in the United States, we have encouraged an expensive, fragmented, and mostly hospital-based system of specialty care.
How soon hospitals are able to go back to business as usual once the current crisis ends is an open question. It may not be easy for them.
What is left of the US primary care system will need to step up in an attempt to handle a good chunk of this other needed care delivery once the current crisis eases. Bringing physicians and nurses out of retirement in local communities to work in primary care offices and urgent care centers is one required step.
Moving whatever basic primary care we can to the virtual space, whether via phone or computer, is a second step. Making some primary and urgent care offices in local communities remain open 24 hours a day, with certain hours allocated for specific types of care delivery, and staffed accordingly, is a third step. Redesigning workflows in these offices to improve care efficiency is a fourth step. Providing added financial support to these offices, in the form of enhanced reimbursement, underlies it all. These steps may require many months to be implemented. Still, when the time is right, we have to try.
The COVID-19 pandemic is like nothing we have seen in our lifetime. We must do everything possible to lessen its potential destructiveness. That includes making sure we do not forget about the other important care patients require to stay healthy and function. If we do, we risk emerging from this crisis with a population and workforce much less able to contribute to making our society and economy strong again.
This article was adapted from Medical Economics®, the sister publication of Oncology Nursing News®. Visit medicaleconomics.com to read the full story.
Timothy Hoff, PhD, is a professor of management, health care systems, and health policy at Northeastern University in Boston, Massachusetts; a visiting associate fellow at the University of Oxford in England; and author of Next in Line: Lowered Care Expectations in the Age of Retail- and Value-Based Health.
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