The lasting impact of the COVID-19 pandemic on our healthcare delivery system

As the COVID-19 pandemic rages across the country, it has brought unprecedented strain on hospitals and clinics, from a shortage of testing and medical supplies to issues in access among rural and underserved populations. The disease has put a spotlight on some of these inequities, while also revealing holes in the healthcare delivery system that can have lasting side effects on patients and providers.

UC Berkeley researchers took up these and other issues Monday during Berkeley Conversations: COVID-19, which focused on COVID-19’s long-term consequences for the healthcare system.

“We are seeing a balance between amazing acts of courage and heroism as our frontline healthcare providers lean in to take care of people across the nation and the world,” said Kimberly MacPherson, faculty program director for health policy and management at the School of Public Health and distinguished teaching fellow at the Haas School of Business. “At the same time we are seeing a bright light focus on the challenges that we knew were already there in the healthcare system and the public health infrastructure. We now have an even more important opportunity to address them.”

MacPherson moderated the online conversation with five healthcare system experts. Topics included: What will be the lasting impacts by both the pandemic and the subsequent recession? And beyond these impacts, how do we take advantage of the crisis to initiate change?

Stephen Lockhart, chief medical officer of Sutter Health, said that the COVID-19 crisis highlights the structural and systemic racism that exists in society and the healthcare system.

“It clearly exists, it is clearly taking its toll, and in the case of COVID-19, it’s costing lives,” he said. “It’s a moral imperative for us to address that. This is an opportunity that cannot be wasted.”

Just as social distancing measures require public participation to be effective, Lockhart said that making “a dent in healthcare to provide much needed public health support” will require collective backing from communities.

For public health professor emeritus Stephen Shortell, that means public-private partnerships led by “competent changemakers,” as well as universal coverage and a better system for national emergency preparedness for future pandemics.

Lynn Barr, CEO of a network of health care organizations called Caravan Health, said the crisis exposes the failures of the fee-for-service healthcare model. In many rural communities, Barr said, hospital and clinic visits have plummeted, which has lead to pay cuts and layoffs for healthcare providers.

“If there’s ever a time when this system is imploding, it’s right now. Fee-for-service doesn’t work when there’s no service,” she said. “I’m hoping this is an opportunity to think about ways we can provide a salary for our primary care providers and make sure we have access to care for all Americans.”

Jane Garcia, CEO of La Clínica de la Raza, a network of clinics in the East Bay, has also seen a decline in patient visits, which has led to a 25 percent reduction in her workforce. She also emphasized the importance of universal coverage, as well as innovations for continuing to deliver care when patients are unable to visit clinics. One innovation she has adopted is telemedicine.

“One of the positive outcomes of this is that telehealth has been demystified,” she said. “We are able to do 90 percent of our visits using telehealth.”

Richard Levy, chair of the Berkeley Public Health advisory council, said that there is a large gap between spending on healthcare and spending on public health infrastructure.

“We’re spending all this money on healthcare, but we are underrepresenting public health in that expenditure,” he said.

But that has started to change in the last few months. COVID-19 has highlighted the need to better care for those experiencing homelessness by providing adequate shelter and food. Other public health experts, meanwhile, have started to address the unsafe conditions in nursing homes.

Overall, the panelists, said, the pandemic has revealed an urgent need to address gaps in the country’s public health infrastructure.

“Will this continue? That’s hard to say,” said Levy. “But I can see a very positive outcome for public health in general.”