Hälso- och sjukvårdssystemet har under de senaste månaderna utsatts för stora prövningar med anledning av Covid-19- pandemin och väntan på vaccin dröjer sannolikt minst ett år till. Professor Patrick Jeurissen, som medverkat på Forums internationella workshops, skriver om dessa utmaningar i dagens blogg. Han lyfter dock främst fram de möjligheter som pandemin öppnat upp i hälso- och sjukvårdssystemet,  där systemförändringar som vanligtvis tar långt tid, blir till hållbara lösningar. Läs bloggen för att ta del av fler lärdomar och möjligheter!

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COVID-19: A Window of opportunity for Positive Healthcare Reforms

Patrick Jeurissen

The current COVID-19 crisis has been testing even the strongest healthcare systems vigorously during the past months. The United States already mourns over 100.000 deaths, while much smaller Sweden has passed 4.000. Nevertheless, the current slowdown in the growth of such numbers, the future looks grim with the vaccine being at least a year away. However, also some positive side effects may come of this  crisis. A rare window of opportunity might have opened in usually slow-adjusting healthcare systems. This might actually contribute to the sustainability of our future health systems, as we have argued in a recent perspective that you can find here.

For example, we have witnessed rapid adoption from a variety of E-health initiatives ranging from teleconsultations and worldwide COVID-19 tracker applications to tertiary care with telemonitoring for patients with chronic heart failure. Whereas past adoption was often slow and cumbersome, the recent adoptions seems to know few institutional and regulatory boundaries. When the stakes are high and urgent, previous boundaries apparently are not applicable anymore. Policymakers face an unique opportunity to seize for the moment. Not only to evaluate the new E-health applications and quantify added benefits, but also to scale these techniques or make them mainstream and thereby increasing the sustainability of our health care systems.

In order to withstand the overwhelming demand on acute care from the Corona-virus, a huge amount of non-urgent elective care had to be postponed. This care constitutes both high-value care but also low-value care. COVID-19 might give us an opportunity, for the first time, to be one step ahead of low-value care, which threatens the financial sustainability of many healthcare systems without adding benefits. Whereas many past initiatives focused on the reduction of low-value care, new initiatives can focus on preventing their restart, for example by adopting watchful waiting and evaluating the health outcomes for those patients that now are ‘denied’ certain (low-value) treatments or diagnostics. This will provide valuable information, allowing for a larger share of more effective high-value care in the future.

Third COVID-19 presents some lessons on the coordination and organization of healthcare delivery systems. The invaluable cost-effectiveness that many studies have tied to a high performing public health system that can prevent, track and destroy infectious diseases is now visible in real life. This includes (inter)national cooperation and coordination, that can be highly advantageous even critical for combatting threats that don’t recognize boundaries. Minimum levels of critical infrastructure are needed. Contamination between different delivery streams (for example acute, elective and chronic care pathways) must be prevented. Scalability of essential professionals such as IC nurses might be helped by a reserve workforce.

Finally, COVID-19 shows the huge value of professionalism as a third logic between the public and private markets.

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Patrick Jeurissen, Chief Research Scientist at Ministry of Health, Netherlands and Professor Sustainable Health Care Systems, Radboud University Medical Centre Nijmegen.