This unexpected hospital crisis caused by the arrival of Coronavirus should make us reflect on the need to strengthen public-private collaboration and how the measures adopted by governments simultaneously affect the economy and the health system as a whole.
María José Hernández and Rafael Caviedes – MC² Salud Consultores – El Libero – published on May 05, 2020
The Coronavirus crisis has put the health system on a precipice; paradoxically not because of an overload of Covid-19-infected patients, but due to an absence of patients being treated for other ailments in medical centres, clinics, and hospitals. Incidentally, the presence of people with or suspected of carrying the virus has forced emergency centres to adapt their facilities to receive them safely and quickly. But Minister Jaime Mañalich himself has warned that the demand for non-coronavirus-related healthcare services «has collapsed» and warns that this may be «a time bomb». How have the waiting lists been affected? What about people who require the resources – doctors, nurses, and wards – and services that are now being used for COVID-19? Are illnesses such as cancer, heart attacks, traumatic accidents, etc. being detected and attended to in a timely manner? How many people are going to die or see their health conditions deteriorate due to a lack of a timely diagnosis and treatment?
Everything suggests that in reallocating significant resources to the healthcare emergencies there has been a significant change that affects all other patients, both in the public and private systems. Whether due to the population’s fear of approaching a hospital for treatment or due to the forced reorientation of medical resources to resolving the crisis, all other diagnostic processes and treatments have been displaced, restricting outpatient care and elective surgeries, delays which will lead to more complications in patients’ conditions at a later stage, which will likely now be more serious and expensive to treat. Thus, for example, available data shows there has been longer wait-times and a decrease of 40% in visits for acute myocardial infarction at emergency centres.
But this crisis has not only put people’s health at risk, no, it endangers the economic stability of the very hospital networks that today are the «front line» in the battle against Coronavirus. In Argentina, Colombia, Spain, the United Kingdom and the United States, private healthcare networks have warned the authorities of these serious economic effects. In Chile, the ASOCIACIÓN DE CLÍNICAS has indicated that the current operating conditions, with activity reduced to 80%, will mean CLP245,000 million in lost revenues, placing liquidity strains that very few providers will be able to bear. Signs of this economic instability have been shared by the Red de Salud UC Christus and the Clínica Universidad de los Andes, who have applied, under the emergency «Employment Protection Law», for permission to furlough their healthcare professionals without firing them and so maintain some social security guarantees and labour rights.
Of all these countries, even those that appear to have a robust state health system, the private sector plays a fundamental part in public healthcare delivery. In Chile, it provides; about half of the medium and high complexity treatments; 36% of ICU beds; and essential support in implementing government policies to deal with the pandemic, as reflected in the significant investments made in respirators and other equipment required in this crisis – all made by private clinics in Chile. Therefore, it is important to preserve (and reinforce) this much-needed collaboration and avoid regulations that result in a weakening or creating an economic crisis in the health system. Working against such a premise is the tendency to apply counterproductive measures that can provoke further damage to the sector, such as fixing the prices for services provided by private clinics attend to patients covered by the state system, without any consideration for the increases in the healthcare delivery costs, which have increased three or four times. Thus, for example, by fixing the price of Covid-19 diagnostic tests may well restrict the supply, so affecting the timely testing of patients who may be contagion risk. Regardless that the authorities must control abusive behaviour, these situations seem to ignore the essential role that price plays in an economy based on supply and demand.
In any case, it would seem prudent to consider the progressive relaxing the constraints on outpatient consultations – with the appropriate preventive measures – to proceed with the delivery of safe and timely health to the population at large. Likewise, in this period of feverish regulatory activity, legislators must be prudent to ensure that regulatory and legislative initiatives consider the particulars of this emergency that needs to be faced with flexibility and haste. Spain is now proposing to restart activities gradually, scheduling care for patients with chronic diseases, using technology such as telemedicine and then continuing treatment through virtual assistance. In addition, and with an aim to secure better conditions for healthcare workers, Spanish health insurers have set up a solidarity fund of EUR37 million to cover healthcare professionals affected by the virus in the event of hospitalization or death.
The coronavirus has created a false dichotomy between the health and the national economy, whereas, in fact, a balance between both aspects is needed as they are both closely related. Thus, the unanticipated Coronavirus-led hospital crisis should make us reflect on the need to strengthen public-private collaboration and assess the appropriate governments measures to be adopted as they affect both the economy and the health system as a whole.
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