A new spotlight on the health sector
It has always been said that health – and life itself – is the most precious thing we have. However, we needed the COVID-19 emergency for a harsh wake-up call and to realize how much we depend on it, not only at an individual level but also collectively, and not only for health issues but also economic ones. Let’s hope that this new spotlight on the health sector does not fade but rather helps society and our governments fight for sound and resilient healthcare systems in every sense; beginning with appropriate and sufficient human capital through to decent budgets that allow healthcare emergencies like the one we have just experienced to be dealt with properly.
It would seem that the impact in terms of lives lost has yet to be fully revealed. At the time of writing this article, there have been more than 2,000 deaths from COVID-19 in Colombia and close on half a million worldwide. The impact on mortality from non-coronavirus causes during the pandemic is still unknown. One report published by the BBC in London on 19 June mentions 124,000 “excess” deaths in a list of countries on top of those caused by COVID-19 itself to date; in other words, deaths caused by the fact that healthcare systems were unable to respond to the pandemic without reducing the care given to other causes of morbidity and mortality, such as chronic diseases. Moreover, this number does not consider the as yet unknown figures in this regard from Latin America. Is it partly because many healthcare systems have overly prioritized treatments based on their cost and disregarded the implementation of models that guarantee the continuity of treatments either in or out of hospital? Are we sure that States have dedicated sufficient resources to healthcare while considering their ageing populations, the increase in comorbidities and inequality in access to healthcare?
“The emergency took both developing and developed countries by surprise equally”
To provide just one example of this, Colombia (a Member State of the OECD) spends US$ 960 per capita on healthcare (7.2% of GDP), while the OECD average stands at almost US$ 4,000 (8.8% of GDP). These figures are a reflection of vulnerability in the healthcare system and, consequently, the economic system in general, which has been clearly shown to be more dependent on the health of its population than anyone could have possibly imagined a few months ago.
That said, reacting to emergencies – such as the one we have seen recently and that will certainly not be the last – force budget limits to be shattered, debt to be increased and home care models or biosafety conditions to be put in place within days, leading to less effectiveness and higher short- and long-term costs. The emergency took both developing and developed countries by surprise equally.
The effects around the world are surprisingly negative, but we cannot ignore the fact that the overall impact on lives and economies is stronger in countries with the weakest healthcare systems.
“It is time to stop choosing technologies based on the lowest short-term cost and escape the cost/ effectiveness trap”
This requires everyone who works in the healthcare sector to strive for truly resilient systems; in other words, systems capable of responding to the needs of patients in “normal” situations but also capable of responding to unexpected emergencies. Is there anything better than prevention for achieving this goal? For example, we know that comorbidities are one of the main causes of mortality in patients infected with COVID-19, obesity, cardiovascular disease, asthma, cancer, etc. Would it therefore not be prudent to treat these diseases to the best of our ability as a matter of course in order to prevent deaths while also reducing costs and risks for the system?
This will involve efforts and investment on several fronts: an increased number of qualified professionals, better installation and equipment infrastructure, and care models and information systems capable of guaranteeing the continuity of therapies even under exceptional circumstances such those of recent months. Nonetheless, we should never lose sight of the ultimate goal for healthcare systems, which is to seek the best possible results for the population. Otherwise, we will continue to carry a heavy burden of disease, unnecessary complications, infrastructure
over-occupancy and unsustainable long-term costs. It is time to stop choosing technologies based on the lowest short-term cost and escape the cost/effectiveness trap that has been shown to never have truly considered how important health actually is and that impacts on other extremely important factors for population well-being – quality of life. A holistic approach to investments in health is absolutely essential and their results must be considered over the long term.
The path to follow must be defined by society and hopefully understood by governments because it will lead to a new set of priorities and, very probably, changes in the size and distribution of healthcare budgets. A new definition of “value” will emerge from this pandemic; one that considers the positive impact of each technology for patients but also their value for society as a whole. Let’s hope we can understand the benefits of protecting research and innovation because those systems that have wisely driven and engaged in this activity are producing the best treatments for COVID-19 and any other disease that might affect us in the future.
I want to imagine that, after this crisis, we will all understand the spotlight that should be placed on healthcare systems for economic and social development, and that those of us in any way related to it will band together to ensure that spotlight is developed and maintained. It is the least we can do for those who have suffered from this pandemic, the relatives of those who are dying, the healthcare professionals carrying a heavier burden today than ever before and the millions of people affected by the economic crisis, who expect to have a system that enables them either individually or collectively to enjoy conditions conducive to developing their potential for the benefit of all.