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What will be the impact of the Covid-19 pandemic on healthcare systems?

For the first time in history, a healthcare crisis has brought down the entire world economy, painfully demonstrating how close healthcare and the economy are. Is health in essence more important now? Or does the constant flow of digital information exacerbate fear and influence political decisions? Or is it because the so-called "developed markets" were affected this time? This article will not attempt to answer these questions; However, it is essential to put the future of health systems in context.

All over the world, our health systems are not designed to face this crisis - a large-scale, unpredictable health challenge that requires urgent mobilization of resources and affects the entire population. Therefore, the discussion about the capacity and efficiency of these systems to deal with them is not relevant in itself. In many ways, the Covid pandemic is completely incompatible with the direction healthcare systems have taken, particularly in developed countries, over the past few years.

Focus resources on chronic noncommunicable diseases such as diabetes and cardiovascular disease.

  • Health problems related to lifestyle changes and an aging population have made this type of health burden more relevant to health systems than epidemics. As Zhou Maing of the Chinese Center for Disease Control said last year, "Looking ahead, the burden of chronic health problems, especially among the elderly, will far exceed infectious diseases."
  • People over 65 will represent more than 11.8% of the total population in 2023 and will peak at 29% in Japan and 22% in Western Europe 2.
  • The number of people living, for example, among chronic diseases, with diabetes is expected to increase by 48% to 629 million by 2045, with China (114.4 million), India (72.9 million) and the United States ( 30.2 million). List 3.

Leading competition, shifting care from hospital to outpatient

  • In France, the number of overnight hospital beds decreased by 4.2%, while outpatient care beds increased by 7.4% and home hospitalization increased by 3.4% from 2013 to 2018.
  • In the United States, total hospital admissions for outpatient services grew from 30 percent in 1995 to 47 percent in 20165, while in England, from 2012 to 2016, the increase in inpatient admissions was 9 percent and the outpatient attendance rate increased by 10 percent. 21 percent for the same period. Period 6.

Stimulate innovation for the smallest, unmet needs and primarily vulnerable populations, and increase relative focus and spending on specialty care.

  • Rare disease patients make up less than 0.06% of the US population, less than 0.05% in the European Union, and less than 0.04% in Japan. By contrast, global orphan drug sales are expected to double by 12.3% over the 2019-24 period. By 2024, orphan drugs are expected to account for a fifth of prescription drug sales worldwide, amounting to $ 242 billion. In parallel, oncology is expected to have approximately 20% of the global market by 2024 and 11.4% in compound annual growth rate (CAGR) growth.

Reduce investment in comprehensive prevention

  • In 2015, less than 3% of health spending was allocated to prevention in OECD countries. Most of these countries spent between 2 and 4% and have been stable in the long term. In addition, almost 50% of prevention spending went to health control programs, such as checkups and dental check-ups, and 25% to health promotion, while immunization and screening programs accounted for less than 10% each. This raises the question of resource allocation; While many immunization activities and some screening activities have proven cost-effective (and some save costs), there is less consensus on the effectiveness of public screenings (including dental screenings).

The immediate and short-term challenge: the Covid emergency and its side effects

Leaders around the world are taking emergency action to address this health crisis, adjusting in real time and "dedicating every day to correcting the mistakes they made yesterday."

In the short term, health systems will face two additional important "secondary" problems. The first will be the physical and mental exhaustion of the medical staff, along with the dilapidated hospital infrastructure. The second is the growing "backwardness" of sanitary measures. For example, the inability or fear of high-risk patients to see a doctor disrupts chronic disease management and delays some critical cancer care procedures. In France, consultations have decreased by 40% among general practitioners and by 50% among specialists since the beginning of the epidemic, even if the increase in teleconsultation is taken into account. At the same time, cancer centers decided to postpone surveillance consultations and operations considered non-urgent.11 In addition, containment measures (and the gradual end of confinement), aggravated by the economic recession, will undoubtedly affect mental health (such as anxiety and depression) and physical health (such as weight gain and unbalanced nutrition.

Long-term vision: addressing a new reality while preserving sustainability

The COVID-19 pandemic will have a long-term impact on health systems, which must be addressed by health and political authorities as soon as possible.

Noncommunicable diseases will continue to increase (expected to account for 75% of all deaths in 2030) compared to 63% in 201312. Within these, chronic cases are associated with intensive use of healthcare resources, for example, 70% of total health financing. In England it is spent on 30% of the population suffering from long-term illnesses 13. In addition, mental health is expected to become the leading cause of morbidity and mortality worldwide by 203014. In parallel, the current management of infectious diseases, including Through vaccination, approach.

So further, how will health care systems that are already limited in resources (rewritten) be reconfigured to improve their ability to deal with a large-scale unpredictable health crisis like Covid while preserving their sustainability?

The current crisis will inevitably change the world we know. In a recent article 15, we outlined scenarios to illustrate the different ways our world could develop after the crisis, in five dimensions:

  • Economy: Will world economies recover after absorbing a passing storm or will they enter a prolonged recession?
  • Society: Will social cohesion increase with increasing appreciation of personal and family relationships, or will xenophobia and suspicion of others decrease?
  • Politics: Will governments around the world gain trust and become more important to international organizations like the World Health Organization, or will they embrace isolationism to protect their constituents?
  • Technology: Will technological progress continue or will it diverge between different markets, with a focus on developments in monitoring and control measures?
  • Sustainability: Will the focus be on sustainability, including climate change, or will it decline as countries move towards energy independence?