In the wake of a global pandemic, healthcare coverage ≠ access to care

By:

Mar 24, 2020

How do we address COVID-19? A recent Op-Ed in the Los Angeles Times made the point that without universal healthcare coverage, we have no hope to tackle it. That’s a fair point; no one should have to worry about the cost of going to the doctor when they feel sick, especially in the face of a global pandemic. But expanding cost coverage in an emergency is only half of the battle. Insurance doesn’t help when it’s still virtually impossible to access timely care.

The Institute of Medicine defines access as “the timely use of personal health services to achieve the best possible health outcomes”. For coverage to make a difference, people need to be able to access the level of care that makes sense for them, at a point in time when that care is most effective. Our current health system fails on both accounts. 

In 2016, 17% of all adults and 35% of low-income adults reported waiting six days or more to see a primary care provider (PCP) when they were sick and needed care. Even with same day or next day appointments, wait times at doctors offices can take hours—time that most people don’t have. And wait times to get appointments in general are rising. In many cases, by the time a patient can see a doctor, their concern is either gone or has accelerated to the point where the ER is the only option. 

For COVID-19 specifically, the lack of available tests is a growing concern. While this certainly exacerbates the problem, it’s important to recognize that even if tests become available, it won’t be enough to minimize spread. Even before the pandemic, America’s shortage of PCPs and hospital beds left our healthcare system unable to handle the country’s health needs. Now we’ve reached the point where we’re seeing triage centers set up in parking garages, hospitals turning empty college dorm rooms into overflow space, and elective surgeries being canceled. Our healthcare system cannot fight an epidemic simply by expanding insurance coverage or offering tests; not if it remains unable to help patients in need. This is why public health officials are asking for help “flattening the curve”—there is not enough care for the people who currently, and will eventually, need it. 

Innovation can fix our broken system

America’s health system is designed to address everything under one roof, resulting in overhead costs and inefficiencies. Consider our primary care crisis. While a number of factors are contributing to physician burnout, most relevant to this discussion is the fact that PCPs are expected to take on all health services that hospitals won’t provide. This puts a huge burden on existing providers, making it challenging for patients to see a doctor when they need one. Patients who are unable to access primary care are forced to go to the hospital, a far costlier option, when their condition severely worsens. Unfortunately, hospitals suffer from the same problem as PCPs: because they take too much on, they’re also overcrowded and ill-equipped to handle high patient volume. 

Our healthcare system is broken, and needs to be rebuilt from the ground up. It starts with unbundling the system’s predominant one-size-fits-none business model, and developing new, innovative models that provide the specific care patients need, when they need it, without sacrificing cost. For example, if primary care practices were solely designed around being a gatekeeper for a patient’s health and performing simple diagnostics, and hospitals were separated out under different business models depending on the type of procedure being performed, the system would not only be more efficient, but also better equipped to serve people at the time they need care. 

By unbundling business models, a few things are accomplished. First, patients know exactly where to go for their specific healthcare needs. This can eliminate overcrowding, as everyone doesn’t go to the same location for different problems. Second, each practice is so well-defined that PCPs no longer feel overburdened, reducing America’s physician burnout and shortage. Since patients are no longer turning to ERs as a last resort, hospitals also see a reduction in overcrowding. The end result is that patients receive the care they need when they need it—regardless of whether or not we’re in the middle of a pandemic.

Can all this work be done in time to tackle COVID-19? No. There is simply too much to be done. But this is not the first, and it won’t be the last time that this kind of medical event takes place. If we start now, we’ll be well-equipped to handle the next medical emergency, whenever it rolls around in the future.

Jessica is a research associate at the Clayton Christensen Institute for Disruptive Innovation, where she focuses on business model innovation in healthcare, including new approaches to population health management and person-centered care delivery.