BrazilHalf of GCC's regular healthcare on hold due to Covid-19
The impact of the Covid-19 crisis is having a major impact on the ‘regular’ care delivery in the GCC. According to a study by GS Health, around ~50% of all regular care is cancelled, leading to 8 million fewer patient contacts per week. Meanwhile, postponing care delivery poses health threats to patients and creates an immense backlog, which leads to increased waiting lists.
On a regular day, there are more than 2 million contacts between patients and providers in the GCC. However, since the outbreak of the new coronavirus, there is nothing regular about this anymore. In order to free up resources for Covid-19 patients, givers and patients themselves are postponing or cancelling regular care.
Analysis by healthcare consulting firm GS Health shows that around half of these contacts is now on hold. “This means that many patients do not receive the care that they normally receive, and many providers are not able to do their jobs. The majority of this is hospital care, of which roughly 50% has currently been cancelled,” explains Mischa van Prooijen from GS Health.
For example, most elective surgeries have been cancelled: appointments for new hips, cataract surgeries, incontinence procedures, varicose veins or plastic surgery. Also, in most cases, major procedures like gastric sleeves or heart valve replacements are postponed, and so are oncology treatments including CT scans or chemotherapy and also for breast cancer diagnostics.
Meanwhile, the coronavirus appear to be having an impact on the Emergency Department. People are scared and avoid hospital visits, meaning only the critical cases show up. Moreover, people wait as long as possible with their visit, which in turn saddles emergency medics with worse symptoms to treat.
In primary care, patients are in masse numbers avoiding clinics. Kees Isendoorn from GS Health: “We see an average decrease of 70%. Most waiting rooms are empty and from an average 20 consults a day most family physicians currently do 2 consults a day.” Here, a fair share of care can be delivered remotely (such as consultations by phone or online) and most patients seem to postpone their care.
“Dental care is the sector where we see the highest collateral damage; it almost entirely stopped,” says Van Prooijen. At current, dentists only perform emergency care treatments, like replacing a crown or pain treatments. Regular check-ups, filling cavities, hygienic treatments and orthodontists are all postponed until further notice. The same is true for the demand side – “most people with light problems cancel their appointments.”
In the case of mental care, treatments such as outpatient treatments and clinical treatments like electroshock therapy have decreased to a bare minimum. “Individual, ambulant care proceeds, but often in a different manner, using online or phone solutions,” says Isendoorn. In similar fashion, allied health has come to a standstill, with the care delivery of physiotherapists (the largest group of allied health professionals) down by some 65% compared to before the Covid-19 outbreak.
How long is this sustainable?
The question is: how long can GCC’s people cope with the situation? Obviously, if the situation would return to normal in a few weeks, a huge operation could be launched to catch-up all postponed care. But, say Van Prooijen and Isendoorn, “this scenario is not very realistic.”
More realistic is that the pandemic will take longer to fight, and that waiting lists will increase at a fast pace. The issue here is that for some patients, their symptoms will worsen: a troubled spot on the skin could develop into cancer, a sensitive tooth may infect, and mental health patients could suffer from a setback when they do not receive proper care in a timely manner.
But, at the same time, another part of the currently postponed care is expected to disappear. It makes no sense to reschedule all missed outpatient appointments for chronically ill patients. Regular check-ups with the dentist will shift forward instead of being repeated. Ultrasounds to check pregnancies will be cancelled and won’t be rescheduled. Moreover, the decrease in sports activities and traffic will lead to fewer muscle strains and broken bones, meaning a lower demand for care.
The combination of these two factors – vanished care and postponed care – will have an “immense impact on patients and care providers” warns the GS Health report. Isendoorn: “For the sectors where the majority of the care disappears, their income decreases. And, for sectors where the backlog increases, most costs continue while income stops. To reduce the backlogs at a later stage, extra funding is required, for example for extra staff.”
Recommendations
In their report, the authors propose three recommendations for GCC’s health sector.
Invest in the shift of care to home
“Organise as much care as much as possible remotely: at the patient’s home.” This indeed has been happening – “driven by the coronavirus, the number of (video) calls as an alternative for outpatient visits and primary care consults is increasing fast; within the past week a lot of the hospitals that we spoke to offer phone or video consults or are even launching apps to deliver care to patients.”
However, more needs to be done. Van Prooijen: “It is crucial to start delivering other forms of care at home, for example monitoring chronic patients (i.e. heart, lung or diabetes) or the treatment of vulnerable patients that require dialysis or chemotherapy. The same applies for prevention- or treatment programs in primary care and mental healthcare.”
Use the capacity for ‘regular’ care wisely
Even if remote care can be arranged very soon, it is just the start, as many treatments will require a physical treatment. The authors highlight the need for “a national task force of medical specialists and other care professionals to avoid and digest the backlog as much as possible. It requires a plan to prioritise per type of care and make capacity available to catch up on the backlog.”
Part of this solution aims at concentrating corona patients and creating corona-free locations where medics can proceed with the regular care that has been given the highest priority by the experts in the national task force. “Moreover, it is important to redesign the patient pathways to ensure safety for patients and healthcare providers. For example, by including home testing before admission to a corona-free hospital,” remarks Isendoorn.
Limit care avoidance at vulnerable patient groups
The third measure proposed revolves around developing a fast-track plan to avoid ‘care avoidance’ for vulnerable patient groups. “Many patients such as vulnerable elderly and mentally fragile patients are currently scared to visit the hospital or clinic. The risk of care avoidance by these groups is high, especially if this crisis lasts longer,” says Van Prooijen.
Further, there is a large group of people with limited digital skills that should not be overlooked. They may be willing and capable of receiving remote support, but lack the much needed digital skills.
“To implement these recommendations strong central coordination is required. Although this seems to happen across the public providers of many GCC countries, these exceptional circumstances ask for exceptional interference, focused even more on coordination and alignment, within the public sector but also including the private sector,” conclude the authors.
For more information, download the study on the website of GS Health.
