Asking a system that does not function well in ordinary times to protect our health during extraordinary times only serves to shine an even brighter light into the cracks of the United States’ Healthcare System. The COVID-19 epidemic has uncovered deficits in the healthcare system, many of which were obvious long before the outbreak, but have been pushed further into view, as a result. Some of those issues include access to health insurance, tying health insurance to employment, and racial disparities in care.
As the months during the COVID-19 pandemic wear on, we have seen many changes implemented that likely will have lasting effects on the healthcare system as a whole. The sharp drop in vaccinations, regular checkups, preventative care, elective surgeries, and delayed or missed diagnosis, could leave the United States with an increase in serious health issues for the foreseeable future, especially as some changes to the system may ultimately be permanent.
COVID-19 has Changed Health Care for Patients
Changes to the healthcare system that have the greatest potential to affect patients are largely rooted in the system’s ability to deliver routine care, whether someone is going to be a new mother and needs prenatal care, or requires a non-emergency surgery. These new barriers to care pose a direct threat to the overall health of the nation.
Even without a pandemic wreaking havoc on the healthcare system, women giving birth in the United States are doing so in the most dangerous country in the developed world. Despite growing bodies of evidence and research into maternal and infant mortality, women die of simple complications such as preeclampsia or excessive bleeding, year after year, and unlike many other countries, in the United States, care for women is getting worse.
Nonetheless, regular checkups remain critical to a healthy pregnancy, and are necessary for the physician to diagnose conditions that may affect the labor and delivery of an infant. Physicians must work to keep patient contact to a minimum which can disrupt the usual schedule of prenatal care.
Additionally, if a physician suspects a mother may have contracted Covid-19, they may find it necessary to separate the infant from her, at birth. This recommendation comes from the Centers for Disease Control and Prevention (CDC).
Recently, U.S. based obstetricians have either switched to less frequent in-person appointments or turned to telemedicine as their only method of communication with patients. Another recent report from the American Medical Association estimated that physicians, in general, saw between 50 and 175 times more patients via telehealth over the last 10 months than they did prior to the pandemic.
The number of physicians currently using, or considering the use of, telemedicine has skyrocketed because telemedicine technology mitigates the need for in-person contact at a time socially distancing is particularly important. Because of this, it is already becoming a more normalized part of the American healthcare system.
Canceled Doctors Appointments
One of the peripheral issues created by the pandemic becoming increasingly alarming is, missed or cancelled routine doctor appointments. Current recommendations in place from the CDC advise that people should not physically enter a physician’s office unless expressly asked to. However, at a certain point, it becomes more dangerous for a patient to delay care, than it is to risk an in person doctor visit. With ever shifting guidelines, physicians are less likely to delay serious procedures at this stage of the pandemic, but may choose to, depending on how severe the spread of the virus is at the time care is needed.
Missed Elective Surgeries
In addition to missed or cancelled routine appointments, elective, or non-emergent surgeries, are also being delayed. “Elective” does not necessarily mean a patient is choosing to have an otherwise unnecessary surgery; it simply means the surgery is not an immediate emergency, and therefore can be scheduled in advance. Many of these surgeries, if left undone for too long, compromise the ongoing health of a patient and remain critical to a patient’s care.
Though the CDC still highly recommends children receive vaccines to protect them from other viruses, the reluctance to enter public spaces has caused a significant drop-off in child immunizations. During this time it is estimated that up to 117 million children might miss out on vaccines, as a result of the pandemic. The result could be a major outbreak of largely eradicated diseases such as measles or polio.
COVID-19 has Changed the Healthcare System
In addition to impacting healthcare at the individual level, the Covid-19 pandemic has also changed how healthcare is and can be delivered, system-wide.
Loss of Health Insurance
For many, access to health insurance in the United States is directly tied to employment. Since the onset of the COVID-19, roughly 6.2 million workers lost access to health insurance when they lost their jobs, and were unable to qualify for other insurance.
This sudden surge in unemployment—exceeding 20 million workers—has caused many Americans to lose employer-sponsored insurance. But it doesn’t end there; this means families depending on spouses or parents also lose their access to health insurance. In fact, a recent Commonwealth Fund survey showed that 40 percent of respondents, their spouse, or partner who lost a job, were dependent on that job for healthcare.
This reality adds to the 31 million persons who were already uninsured, and the more than 40 million estimated to be underinsured, before the pandemic struck.
Financial Losses for Providers
Though the novel COVID-19 virus has created an unbelievable demand for specialized acute care that has overtaxed some hospitals, it has also facilitated a steep drop off in regular doctor visits and preventative care, which make up a large portion of both clinic and hospital revenues.
Overall, office-based practices had a 60 percent reduction in visits during the first months of the crisis, and, by their own estimates, hospitals will have lost an estimated $323.1 billion in 2020 according to the American Hospital Association.
A small sample of the overall crisis is represented in the statistical analysis of COVID-19 in Chicago, Illinois. Black people account for two-thirds of Chicago’s COVID-19 deaths despite constituting only one-third of its population. These disparities do not just exist in Chicago, the city only serves as a microcosm for the rest of the United States.
Across the country, the story is the same: Covid-19 is killing people of color, particularly Black people, at staggeringly disproportionate rates. Only 13 percent of the overall population in the United States in Black, yet Black Americans die from COVID-19 at triple the rate of white Americans.
A National Public Health Crisis
With only 4 percent of the overall world population, by July 16, 2020, the United States made up 26 percent of COVID-19 cases and 24 percent of its COVID-19 deaths, globally.
Without clear guidance or accountability from national leadership, politically and from within bureaus such as the CDC, states have been left on their own, in large part, to deal with the fallout of the pandemic. Lack of personal protective gear for frontline workers, rampant unemployment and lack of meaningful financial stimulus for U.S. households, lack of comprehensive healthcare strategies, and other important tools and financial resources for hospitals have all left the nation’s citizens vulnerable.
As of January 2021, many states have even relaxed stringent physical-distancing guidelines without careful attention to public health measures needed to prevent resurgence. Looking to the nations who have handled the pandemic best, we see clear leadership and dedicated resources. Only time will tell if the next U.S. Presidential Administration will implement federal mandates or provide ample guidance to state leaders.
Who Bears the Greatest Impact?
The pronounced gap between the richest one percent of Americans and the poorest one percent is only becoming wider. At this point, the wealthy are expected to live, on average, 10 years longer and experience more healthy years in their life. These statistics do not reflect any consideration for the inevitable effects of the pandemic, which threatens to only worsen outcomes for the nation’s poorest.
Outside of the benefits of wealth, COVID-19 has also drawn a clear line between people with white-collar jobs that allow them to follow public-health advice and work from home, and those in service-industry jobs who must be physically present to do their work—thereby risking infection—to earn an hourly wage.
Are These Effects Lasting?
The rippling effects of the pandemic have left millions of Americans without insurance, foregoing preventative healthcare and regular checkups. Undoubtedly, this time in our nation’s history will have negative repercussions for years to come. The pandemic may come to an end, but Americans will continue to feel the effects long after COVID-19 is managed.
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