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Viewpoint
COVID-19: Beyond Tomorrow
May 1, 2020

The Business of Medicine in the Era of COVID-19

Author Affiliations
  • 1Department of Economics, Harvard University, Cambridge, Massachusetts
  • 2Vanderbilt University Medical Center, Nashville, Tennessee
  • 3Harvard Business School, Boston, Massachusetts
JAMA. 2020;323(20):2003-2004. doi:10.1001/jama.2020.7242

The United States will eventually get through the acute coronavirus disease 2019 (COVID-19) crisis but not without fundamental changes to the medical care system. Since the epidemic began, payment policy has stretched to remedy the bias of the health care system for in-person treatment provided by physicians. In response to the need for social distancing, new policies include broader payment for telemedicine, expanded scope-of-practice ability for nonphysician practitioners, and increased ability of physicians and nurses to practice across state lines. While these policy reforms address some of the immediate needs of this crisis, such as getting personnel to where they are most needed, they are not a complete solution to the COVID-19 crisis. How the aftermath of the current COVID-19 wave is handled will be just as important for the business of health care as what is happening now.

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    2 Comments for this article
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    Business As New - The Post Covid-19 state of Healthcare
    Vikas Wadhwa, MBBS, MBA, MPH | Peninsula Health, Victoria, Australia
    Cutler et al’s paper on The Business of Medicine in the Era of COVID-19 captures much of the essence of what will become "Business as New”. The current pandemic has propelled global healthcare systems into hyperdrives of change, necessary to deal with the surge in demand. Whenever and wherever the points of relative stability are reached, there will likely continue to be vast differences within and between nations. The hope for markedly improved access to care and sustainability through unleashing telehealth may be well founded. However, with true pragmatism, the current inequalities, biases and suboptimal clinical outcomes across minority groups are for the majority unlikely to disappear.

    Major transformative change is happening and further evolution inevitable and unsettling. The uncertainties carry risks for staff and patients alike but also for the funding and regulation of healthcare services. Most hospitals have seen the number of emergency room presentations drop well below 'normal' levels with patients too afraid to attend due to the fear of acquiring CoVID-19. How patients continue to respond and seek out essential services in the future and how they will persist with technological media to interact with healthcare professionals will remain to be seen.

    In the delivery of healthcare, trust and a highly personal experience have always been a centrepiece. The profession now faces major challenges to ensure that its rapid but necessary adoption of innovative risk reduction strategies and technology does not diminish the empathy and compassion that accompanies the traditional face to face clinician patient relationship.

    {Vikas Wadhwa, Chief Medical Officer and Helen Cooper, Chief Operating Officer, Peninsula Health, Victoria, Australia}
    CONFLICT OF INTEREST: None Reported
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    The New Business of Medicine
    Mike Fernandes, MD | Retired physician
    In their Viewpoint the authors address possible changes in the business of medicine in the post-COVID-19 environment. However, their analysis is focused on the supply side, namely, what type of organizations will be available to treat patients a few months from now? And how will those patients be most effectively served? Medicine is different from a simple two-sided transactional retail business, and analysis and projection has to consider the economics of the system. Here, we have three stakeholders: doctors and hospitals, patients, and insurance companies. And the latter determines the type of service, the need, the premiums/copayments borne by patients, and the reimbursements to doctors and hospitals. In order to be sustainable, the system has to be both profitable and satisfying to doctors and patients. From the demand-side, and in the post-COVID world, one should ask whether patients can afford to adapt to this change. The COVID hit to the economy has had a huge impact on both the supply- and demand-side, and it is likely that the business of medicine will reflect this change. The new expectation of the business of medicine has been explained by Bernie Sanders in the Guardian: "The pandemic has made the US healthcare crisis far more dire. We must fix the system (May 2, 2020)." The economics of the new business of medicine, especially the demand-side, needs further study. Rearranging the deckchairs on the Titanic is not enough.
    CONFLICT OF INTEREST: None Reported
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