While COVID-19 has introduced many unforeseen societal challenges, it has also magnified and exacerbated ‘pre-existing conditions’ within healthcare systems around the world – whether they be a lack of sight into population health, poor infrastructure for digital care delivery, or the disproportionate health impacts to underserved communities. It has also made many people come to realize that there is truth in the “health is wealth” adage.
Pre- and post-pandemic, healthcare systems have and will continue to face increased pressure amid aging populations, the growing burden of non-communicable disease, spending constraints, tougher regulations and workforce shortages. It is estimated that there will be a shortfall of over 18 million healthcare workers by 20301. This deficit is likely to deepen as result of COVID-19 as will issues related to the ways that care has been traditionally organized and delivered. Around the world, many healthcare systems are often reactive and configured to treat people at times of crisis in hospitals and are poorly designed to work on prevention or proactively treat people at or near home.
The above-mentioned pressures coupled with COVID-19’s impact are pointing to a dire situation where care demand will eventually outstrip supply, creating a care gap in the future. Globally, health system leaders need to put actionable plans in place to start bridging this gap.
Earlier this week I had the pleasure of joining a World Economic Forum Davos Agenda virtual session on health system sustainability and resilience. During this session participants discussed the policies, practices and partnerships that are needed to radically improve health system effectiveness and resilience.
Listening to the session a number of points stood out: COVID-19 has shown us that ‘no one is safe, until we are all safe’. Globally, there needs to be much more focus on health and healthcare-accessibility for vulnerable groups. The short-term effect of neglect has caused higher mortality in these groups and hampered systems ability to gain control of the crisis. Longer-term effects of neglecting these populations will not only further increase inequity, but also threaten the recovery of our economies. Universal health insurance coverage is an important step in addressing these inequalities. A change in mindset is needed where healthcare is considered an investment rather than a cost that needs to be minimized. When investing in healthcare, the focus needs to be shifted from the treatment of diseases to investing in prevention, early detection and intervention and these items need to be covered by health insurance plans. Diagnostics will be key in the coming years.
Based on what I heard this week and what my colleagues in more than 40 countries and territories are saying, the pandemic will provide the impetus for long overdue changes to the way that we receive and deliver care. We need a paradigm shift in healthcare that will take us from siloed to integrated care, from in-person to digital care delivery, to focusing on prevention vs. cures. As a healthcare management consultant, I see health systems as my patients, so below are my four prescriptions for post-pandemic healthcare:
In a post-COVID world, the new reality for healthcare will require a redesign of care systems. Now is the time to embrace broader integrated care networks that place patients at the center to deliver coordinated and consistent health care services. Health leaders will need to scale up primary and community care and improve the integration of care between different settings, with a focus on care at or close to home. The benefits of integrated care are that it is based on good population health management and prevention at scale and increases health outcomes and reduces system-wide costs.
COVID-19 provided a catalyst for many healthcare systems to adopt digital care modalities. In the new reality these virtual care and digital advancements will be sustained because healthcare consumers have now come to expect access to services in a convenient way. Increased use of virtual care can reduce the burden on health resources, such as monitoring patients 24/7 from their home via wearable technology. At the system-level, digital command centers can be established to embed operational management systems for monitoring and managing capacity and performance. Data and artificial intelligence can also be used for population health management and early intervention by targeting specific cohorts who are at high risk for chronic diseases.
Healthcare in a post-COVID world will require a more agile, inter-professional workforce that can deliver team-based care. Staffing models and deployment will need to be rethought according to tasks and competencies rather than roles and job titles. Front-line staff must be empowered to leverage technology (including virtual care) to allow them to focus on higher-value work. Workers will also need to have more flexibility to work outside of the walls of individual organizations and collaborate with other professionals to deliver integrated care.
Public Private Partnerships (PPP) can also deliver higher quality health services at the same or less cost. Low- and middle-income countries have something to teach mature health systems about the possibilities and potential of PPP for health system development. To reduce burden on its over-stretched health centers and increase citizen access to care, in 2016 a country in East Africa forged a partnership between a leading philanthropic organization and a digital health solutions company that saw more than 2 million people — around 30 percent of the adult population sign up for digital care services.2 In 2020, a contract was signed with the company to deliver digital health services for the next decade, paid through the government’s community-based health insurance program.3
COVID-19 has made the case for the importance of healthcare transformation and emphasized the importance of health equity and access in our communities. Health and wealth are interlinked. Health systems cross sectors to support more economically active societies. We need to start shifting paradigms in healthcare by making systemic challenges more obvious, by proving the case for integrated and digital delivery, more flexible workforces and the opportunities PPPs provide.
1 Cometto, G et al. (2016). Health workforce needs, demand and shortages to 2030: an overview of forecasted trends in the global health labor market. World Health Organization website. https:// www.who.int/hrh/com-heeg/Needs_demands_shortages.pdf
2 Strick, K. (2018, July 12). The Rwandan project: how Babylon helped rebuild healthcare in a war-shattered country. Evening Standard. https:// www.standard.co.uk/futurelondon/health/the-rwandan-project-how-babylon-helped-rebuild-healthcare-in-a-warshattered-country-a3885946.html
3 Hospital and Healthcare. (2020, March 11). Rwanda's digital health revolution, http:// hospitalhealth.com.au/content/technology/article/rwanda-s-digital-health-revolution-175185489#ixzz6kJgjDpLa