COVID-19 and the Case for Medical Management and Primary Care

Abstract

Hospitals and health systems suffer an over-reliance on elective surgeries to remain profitable. As a result, systems report record losses, while demand for emergency room, hospital, and intensive care beds have surged. Studies have admitted that many surgeries are unnecessary, and physician leaders admit that profit plays a role in driving such needless cost and risk. Most diseases are better managed with medications and lifestyle changes. But it pays more to replace a knee than to prevent that replacement. We must bring surgical and medical value closer in-line. Communities of color are suffering disproportionately from coronavirus. The social determinants of health that lead to higher concentrations of hypertension and diabetes can be mitigated by investment in primary care. Such investment has been proven to decrease cost and increase quality of life. However, the United States spends 50% less on primary care, than other developed countries. While showing promise, telehealth is not a panacea. It relies on continued reimbursement parity, and there remains a digital divide. Any meaningful fix will draw the ire from those who profit from such a profligate system. If we want to improve quality, access and equity, while avoiding unnecessary hospitalizations, risky surgeries, and runaway costs, we must invest in primary care.

Situasi Pembiayaan Kesehatan Untuk Manajemen Penyakit Tidak Menular Di Pelayanan Primer Berbagai Negara Selama Pandemi Covid-19

“…Di Amerika Serikat, suatu studi menyoroti bahwa dengan adanya COVID-19, dampak dari kekeliruan sistem pembiayaan di pelayanan primer negara tersebut justru menjadi semakin tampak (Domingues & Willis, 2020). Hal itu dibuktikan dengan banyaknya kasus COVID-19 yang terjadi disebabkan karena komorbid PTM masyarakat tidak terkontrol dengan baik di pelayanan primer.…”

“…Dalam studi lain, dijabarkan bahwa di Amerika Serikat sebetulnya sudah banyak care provider (termasuk pelayanan primer) yang mengalihkan pelayanan manajemen PTM seperti diabetes melitus dari yang bertemua langsung menjadi kegiatan virtual care (Hartmann-Boyce et al, 2020). Kegiatan virtual care ini pun sudah diakui oleh pemerintah dan dapat dilakukan reimbursement atau klaim seperti layaknya konsultasi langsung (Domingues & Willis, 2020). Tetapi, ternyata tetap saja klien tidak dapat sepenuhnya mendapat hak dari insurance coverage-nya.…”

Automated conflict resolution for patients with multiple morbidity being treated using more than one set of single condition clinical guidance: A case study

“…This places an enormous responsibility on the often discretionary decision making behaviour of GPs that even before the COVID-19 pandemic were accomodating unprecedented demands on their services and are now coping with fundamental changes to their working environment [5]. The growing pressure being placed on primary care has potentially serious implications for consistency of care, and patient safety [6] and has highlighted the need to improve the integration of existing guidelines and provide more timely, reliable and consistent decision support mechanisms [7].…”