Post-Pandemic Healthcare

Three years on and the coronavirus continues to transform society.

Economists and empiricists alike are fascinated by what this virus has done to the world.

But although the health effects have been immense, but the economic implications are just as complicated.

In general terms, for most of the world, cross-industry employment remains short of pre-pandemic forecasts, particularly in the US.

Economic output forecasts also remain gloomy, with many countries failing to level up with pre-pandemic GDP forecasts.

Inevitably, the virus has had a notable economic effect on the healthcare sector (excluding Pharmaceuticals).

The early attempts to curb the virus were lost in a whirlwind of conflicting objectives and administrative disorder. Gradually, policymakers were able to provide decisive input, and governments soon imposed a temporary deprivation of our freedom to help prioritise the sick and manage the overall demand.

COVID-19’s impact on deferred healthcare equality

What happened next?

Governments became engaged in a lengthy and costly exercise of spending reduction.

Already under pressure, nationwide measures were put in place for the healthcare sector to reinforce this position.

In a blink of an eye, healthcare businesses and institutions dealt with such spending reduction by reducing healthcare employment. This was the start of a chain-reaction of spending reduction, affecting global healthcare systems to different degrees.

Almost every indicator of healthcare economic activity during this period showed a marked decline.

But at the base of such change, these same indicators point towards a potential post-pandemic re-construction of how healthcare systems prioritise and personalise additional patient care, in particular, deferred care.

Recent figures issued by the Health System Tracker and Bureau of Economic Analysis (BEA) shape a somewhat contradictory economic outlook in the US.

Currently, dental spending has been down 12% since January 2020. Nursing home spending has decreased by 5%, and physician spending has reduced by 2%.

Other cost components of healthcare have increased only slightly, with hospitals rising by 1%, prescription drugs also growing. Such variance contributed towards a 3.5% decline in overall US GDP in 2020. But such a fall is superficial.

For healthcare economists and policymakers alike, there is potentially something more sinister lurking behind these numbers.

In reality, this means that the drop in health spending since 2020 reflects a general decrease in spending and prioritisation for non-COVID medical care.

A UK NHS watchdog found enough evidence to suggest that up to 740,000 patients with cancer have gone undiagnosed since the first COVID-19 lockdown which was introduced in March 2020. It’s tough to watch.

Particularly early in the pandemic, it appears many people delayed or went without the medical care they otherwise would have received pre-pandemic.

Healthcare spending for patients outside the remit of COVID-19 did pick up in the final quarter of the year, but it wasn’t enough to make up for the missed patient care earlier in the year.

Why is this the case? Too many healthcare workers resigned, or weren’t there enough healthcare workers to begin with? Did we lay off too many at the wrong time?

This is too difficult to answer right now but during the pandemic, healthcare employees in the US dropped by 9% in 2020. Since then, employment has recovered but remains at 3% below pre-pandemic levels.

The UK is facing similar issues. The Institute for Employment Studies estimates 1 million fewer people across all industry workforces due to higher economic inactivity and population change.

But does this explain why deferred care appears to have been abandoned?

Digitalisation to Revitalise deferred care?

COVID-19 clearly undermined the delicate social and financial balance on which the internal peace of every national healthcare system depends. It ruptured some of the cultural substructures and operable infrastructure, which was previously broken at seams pre-pandemic.

The virus forced the upper hand of policymakers to reduce the number of employees strategically, scaling up the numbers only when required to adequately care for patients.

These strategic changes helped many systems increase productivity and COVID-19 response satisfaction, especially regarding lab services.

Spending on lab services hit a new high in the fourth quarter of 2020, as labs saw a considerable increase in spending from consumers as they started purchasing PCR and Antigen tests.

Yet, as David M. Cutler explained here, the elephant in the room remains. Will new advancements in technology help level up the deferred healthcare bottlenecks?

What to expect from a post-pandemic Digital Healthcare System?

Other healthcare services also decreased considerably during the pandemic, including preventive services, physician visits, and non–COVID-19 hospital admissions.

Although policymakers and governments have adapted and vaccine rollouts have remained relatively prosperous, they have proved quite incapable of restoring pre-pandemic order.

Although successful vaccine rollouts were underway during the pandemic, a new digital and virtual healthcare structure developed.

Clinicians and healthcare facilities who were forced into a situation whereby they had to “care without the caring”, or in other words, “maintaining touchpoints with patients without the touching” - embraced a new virtual and digital healthcare workflow.

The digital transformation that soon unfolded opened up a strategic opportunity barely dreamed of by the healthcare practitioners and clinicians - for example, in remote Telehealthcare.

New innovations in Telehealthcare responded strongest in countries where private healthcare is the dominant system, such as the US.

Still, healthcare systems in regions such as Germany and the UK, where the gap between public and private healthcare is modelled differently and consistent with cultural demands, had to adjust all the same. The new advancements in Telehealthcare have undoubtedly taken the edge of specific deferred care bottlenecks, but problems remain.

Consciously or not, healthcare is now stepping into a new virtual universe, which appears to be consistent with the rise of Industry 4.0.

Although the broader terms of digital transformation still lay in regulators’ hands, decisions on managing virtual knowledge consultation and diagnosis through direct interaction with data still remain open questions - the general direction we are observing is a positive step forward.

I suspect that the prioritisation of deferred care will return, but it may be too late for the most vulnerable. COVID-19 distracted resources and attention from the far more dangerous bottlenecks occurring for deferred care patients. These bottlenecks present a challenge for all healthcare systems, some worse off than others.

Although on the surface, it is a rather bleak picture, our global healthcare systems now have a golden opportunity to revitalise deferred healthcare by investing in new technological advancements.

Now, I certainly don’t want to sound like a techno-optimist here, but there is, nonetheless, an opportunity. But it won’t be easy.

A New Frontier of Digital Health Governance

Currently, there is no scalable introduction to digital healthcare governance.

Another big problem.

Such a lack of a clearly defined framework on digital healthcare governance is clearly causing analysis paralysis for several nations and their healthcare institutions and companies looking to fix a broken healthcare jigsaw.

We have had some breakthroughs with the FDA and the UK’s MHRA new Machine Learning Good Practice guidelines these past few months. Additional primers have been released by the Machine Intelligence Research Institute.

Yet, what appears to be missing is an international standardised governance model that offers substantial breadth, depth, context, accountability, and information on integrating digitalisation and virtualisation into healthcare workflows.

Denmark appears to have noticed this market design flaw relatively early.

Researchers from the University of Copenhagen have just released an innovative algorithm that will help alleviate pressure whenever hospitals are confronted by new waves of COVID-19.

Using a mixture of economic investment, academic incentive and political pressure, the newly designed algorithm can predict how highly likely or unlikely COVID-19 patients will require intensive care or ventilation.

Denmark is now in a position to enable healthcare institutions to prioritise hospitals using what looks upon the surface, like a predictive “dynamic lane-control” system, often used throughout the automotive industry for relieving traffic congestion.

As always, most people’s reaction to investment and technological research like this algorithm depends on whether society agrees with the end result.

I expect, if the results are consistent enough, their work will have a positive impact and alievate deferred care bottlenecks in parallel.

Will we see more innovation?

The pandemic has certainly magnified the need for change. Yet, up until now, digitalisation and virtualisation, particularly AI, has been failing to help healthcare providers revolutionise the industry. An industry where, in theory, AI is to have the most significant influence.

Often, there’s a razor-thin margin between success and failure. I can’t help but think, we have to frame what is currently befalling our healthcare systems through this same prism. It is now made or break.

As we know, big healthcare companies and institutions find it difficult to change course because they get known for a particular set of capabilities. That’s why they need to pivot on their own or rely on innovative companies or startups to get ahead of the curve for them to later acquire.

We are starting to see this particular behavioural trend occur right now throughout the world’s healthcare systems.

As already mentioned, the bottlenecks observed for deferred healthcare from COVID-19 - are causing concern.

Reducing the overhead of general medical care is essential towards balancing the status quo. Revitalising deferred healthcare from COVID-19 is a perfect use case for Industry 4.0 to solve.

Telehealthcare has proven to be a great alternative to expensive medical care settings.

To add more weight, generally, many people are now opting for homecare ever since the pandemic struck, which is a massive opportunity for policymakers and governments looking to get ahead & accelerate Hospital-at-Home programs.

Innovation is a commitment towards collective curiosity

Such curiosity is being spurred on by way of COVID-19 and the new Industry 4.0 technological frontier that lays before us.

So, now is the time to make use of such momentum.

If we are to have any hope at all, policymakers and governments must let this curiosity continue and further establish appropriate and relevant reward systems for those passionate about integrating digital transformation sensibly and proactively into our healthcare systems.

As Jade Leung highlights in her brilliant TED Talk: Why governing AI is our opportunity to shape the long-term future?, she projects an ever-elegant quote of the great Edmund Burke, which I think is worth repeating to close this post:

It is a partnership in all science; a partnership in all art; a partnership in every virtue, and in all perfection. As the ends of such a partnership cannot be obtained except in many generations, it becomes a partnership not only between those who are living, but between those who are living, those who are dead, and those who are to be born.

I think this nicely encapsulates what we need to arrange and cooperatively achieve to get where we need to be.