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Covid 19. Implact on Health Care

Although it is appropriate that almost all the news about Covid 19 is about new cases, and the second wave, there is not much said about how the covid 19 policies that limit medical treatment are effecting the population.  The short answer is that there is likely to be a very large consequence for not going to the doctor for checkups, diagnostics and elective surgeries.  It is estimated that, between March and June,  more than 80,000 cases of the five most common cancers in the US will not be diagnosed because of covid 19 disruptions in elective treatments.  Screenings or breast, prostate, colorectal, cervical and lung cancer were down 39-90% during the week ending on April 10.  The delay in diagnosis and treatment can result in as many as 34,000 excess deaths due to cancer in the US.

Additionally, the number of admissions to oncology outpatient clinical have decreased up to 50%.  It is expected that the majority of the cancers not diagnosed will be breast cancers.

Cancer screenings generally take place in a doctor’s office or at diagnostic centers run by larger health systems.  However, there has been great variability system to system, state to state on how these facilities have responded to cancer screenings due to covid 19.  Some have simply closed, while others open for ‘emergencies’ only.

Cancer patients may be longer term, and somewhat hidden consequence of covid 19.  This is a lot of people not getting cancer diagnoses.

In a more general sense, it is estimated that there will be 28 million who will have had their surgeries cancelled because of covid 19.  The long term health consequences of delaying these surgeries is yet to be determined.  This corresponds to over 70% of all elective surgeries being cancelled.  Of these surgeries, an estimated 2 million will be cancer related surgeries.  Elective surgeries have an extraordinary influence on hospital revenues.  In many large hospitals, elective surgeries account for nearly 50% of the revenue.  The loss of elective surgeries deprives hospitals of their largest source of income.

In the UK, it is estimate that over 40,000 surgeries are cancelled each week elective surgeries are not allowed.  It could take well over a year to catch up on the backlog of surgeries.

It is estimated that there has been up to a 70% decrease in patient visits to doctors from February through April.  In the past month, this has rebounded to the level where there are 30% fewer visits to the doctor than in February.

The moratorium on elective procedures jeopardizes the financial integrity of health care systems that are disproportionately reliant on elective procedures as a revenue source. In response, the U.S. Congress passed the Coronavirus Aid, Relief, and Economic Security Act (CARES), a $2.2 trillion bill with $100 billion designated to hospitals and $350 billion designated to small businesses including private orthopedic practices . Although these relief programs may alleviate some of the economic burden, the legislation is not comprehensive, and it will not resolve all financial losses accrued by health care systems and orthopedic practices. Without the revenue from elective procedures, many orthopedic practices have had to furlough employees and withhold surgeon salaries. Mayo Clinic has announced a projected $900 million shortfall, with employee pay adjustments and furloughs .

 

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