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Global healthcare collapse | The Economist

T.he imposes The lockdown during the covid-19 pandemic had one overarching purpose: to prevent hospitals from being overwhelmed. Governments hoped to space out outbreaks and buy time to build capacity. But eventually, much of this extra capacity went unused. His seven “Nightingale” hospitals in England, like many of America’s field hospitals, closed after receiving only a small number of patients.A study of European experience health policyThe journal found just one case on April 3, 2020, in Lombardy, Italy, where there were more COVID-19 patients than intensive care units. It is too early to know whether these are isolated examples or represent broader systemic failures.

Outside of China, covid has been weighing heavily on people’s minds lately. But the wealthy world’s healthcare system is closer than ever to collapse since the disease began to spread.unemployed or gdp, there are few comparable up-to-date figures for national health care.yes economist To paint a picture of what is going on, we looked at statistics produced by countries, regions and even individual hospitals. suggests that Rather, the effect seems to be delayed.

Let’s start with the UK, which produces great data. National Health Service (NHS), the country’s state-owned providers are in dire straits. Just before the pandemic, a person with an urgent but not immediately attended medical problem, a category that included stroke and heart attack, waited an average of 20 minutes for an ambulance. We have been waiting for over an hour and a half (see picture). The number of long “trolley waits” between admission decision and patient arrival at the ward is skyrocketing.

Statistics are less comprehensive in other countries, but similarly miserable patients. In September, his polling firm Ipsos released a global survey that included questions about the quality of health care. Fewer people say the services they are provided are ‘good’ or ‘very good’ than they were in 2021 in almost all of the 20 richest countries. In the UK, he has dropped 5% in saying so. In Canada he is down by 10. in Italy by 12.

Italian hospitals flooded with COVID-19 patients in early 2020 are once again in trouble. We analyzed data from the Pope John XXIII Hospital in Bergamo. This hospital was the site of some harrowing images of people on ventilators nearly three years ago. In the year COVID hit Italy, hospital waiting lists rose slightly with some measures. It then declined slightly the following year. But in 2022 they took a leap. A person looking for a non-urgent breast ultrasound in the city may have to wait up to two years. Officials in hard-hit Emilia-Romagna in 2020 have launched plans to bring waiting lists back to pre-pandemic levels.

The newspapers of the Anglosphere are full of horror stories. In New South Wales, Australia, in the third quarter of 2022, about 25% of patients will have to wait more than 30 minutes before being transferred from paramedics to emergency room staff, two years ago he was 11. increased from %. In Canada, wait times have reached all-time highs, with a median delay from referral to treatment of six months.

Even the richest and most capable nations feel the strain. There are fewer free intensive care beds in Switzerland than at most of the pandemic. A similar problem exists in Germany, where a surge in patients is reducing capacity in intensive care units (see graphic). In Singapore, as of the end of 2021, patients waited around nine hours to be seen at an average polyclinic. By October 2022, the patient had been waiting for her for 13 hours.

America is doing better than most countries thanks to spending so much money on healthcare. But it’s not working. Recently, the average hospital utilization rate exceeded 80% for the first time. Even in the darkest times of the pandemic, few states have reported that their pediatric wards are under stress (defined as more than 90% of beds occupied). In early November, 17 states were in this position, a result of an increase in bugs of all kinds in children.

Poor quality health care contributes to a staggering increase in ‘excess deaths’, higher than expected in a typical year. In many developed countries, 2022 will prove he is deadlier than 2021. Monthly deaths across Europe are now about 10% higher than expected. Germany is in the midst of a significant rise in mortality. Since September, the weekly death rate is more than 10% higher than normal. It was 23% higher in early December.

what’s going on? Politicians are responsible, both nationally and regionally. However, the factors causing disruption are common across countries and related to common experiences of pandemics. It may also be nearly impossible for governments to overcome, at least in the short term.

Beyond OECD Mostly part of the wealthy countries, health care costs are now gdpand was below 9% pre-pandemic (see chart). Of the 20 countries with data for 2021, 18 see his per capita spending higher than ever before. almost everyone gdp Adjusting these numbers for an aging population does not meaningfully change these findings.

So the problems facing the healthcare system are not due to lack of cash. Much of the increased spending is on programs to fight covid, including testing and tracing and buying vaccines. But funds are now growing more broadly across the system. In almost every rich country, more people than ever are in healthcare. Total hospital employment in 2021 increased by 9% over the pre-pandemic year in six regions. OECD country surveyed. According to the latest data, Canada currently has 1.6 million people in healthcare, the highest number ever.in the EU Over 12 million people are engaged in ‘human health activities’, which is a record. American hospitals employ her 5.3 million, another record.

Perhaps the real issue isn’t the number of staff, but how efficiently they work. Real U.S. hospital and ambulatory care sector output, which measures the amount of care provided, is only 3.9% above pre-pandemic levels, while economy-wide output is 6.4% higher overall. increase. In England, expectant care activity (i.e. pre-planned surgeries) is slightly lower than before the impact of COVID-19. In Western Australia, the rate of elective surgery delays jumped from 11% to 24% in the two years to November.

In other words, hospitals are doing more. Declining productivity is an economy-wide phenomenon, but healthcare is now suffering from additional pressure. A recent paper by Diane Coyle and his colleagues at the University of Cambridge looks at the impact of the UK’s response to covid. The “do and don’t” protocols still in place in many countries today for exchanging protective kits and cleaning requirements after dealing with COVID-19 patients slow everything down. Separation of Covid and non-Covid patients limits bed allocation.

On the other hand, many staff feel miserable after three grueling years.report in Mayo Clinic Minutesmagazine found that a quantitative measure of “burnout” among American doctors soared (see chart). When health care workers become discouraged, they used to stay out, staying late to make sure patient registries were in order, or helping another doctor treat a patient. may be less.

Although productivity has declined, it has not fallen sufficiently to fully explain the collapse of healthcare. This suggests that the real explanation for the collapse lies on the other side of the coin: an explosion in demand.

Coming out of lockdown, people seem to need more medical help than ever before. Some of this has to do with immunity. People said he went two years without being exposed to various bugs. Since then, endemic pathogens such as respiratory syncytial virus have blossomed. Everyone you know has or has had the flu recently.

But the pandemic has also hampered other currently diagnosed conditions. In 2020-2021, many people delayed seeking treatment for fear of contracting COVID-19 or because hospitals were closed due to non-COVID-19 circumstances. In Italy, in 2020 he had a 39% decrease in cancer diagnoses compared to 2018-19. A study of American patients noted a decrease in certain diagnoses over a similar period of time for cancers that are usually detected by screening or routine examinations.

in England, NHS Since the pandemic was declared, waitlists have increased by over 60%. More resources because many of the people on the list, and many on similar lists in other countries, are more likely to get sick than if they were treated in 2020 will be needed. lancet public healthanother journal found that over the next 20 years, the number of deaths from colorectal cancer could be nearly 10% higher in Australia than pre-pandemic trends suggest, in part due to treatment delays. I assume there is.

Covid also continues to increase demand. A recent paper by the Institute for Finance, a London think tank, estimates that illness is reducing the number of beds available in the country. NHS 2-7%. As COVID-19-positive patients tap into resources, providers provide bad care for everyone. A study by Tiemo Fetzer of the University of Warwick and Christopher Lau of the University of Cambridge found that for every 30 or so additional COVID-19 deaths, one non-Covid-19 patient died, which means ” This is due to the poor quality of medical care.”

Needless deaths are not the only consequences of a malfunctioning health care system. People start to feel that their country is crumbling. If you live in a rich country and get sick, you expect someone to help you. And when the tax burden is at or near an all-time high, as it is in many places, someone should definitely be able to help.

The good news is that the backlog created by the pandemic will go away. The surge in respiratory viruses in adults and children has probably reached its peak. Management has made progress in tackling the huge waiting list. But with an aging population and the constant threat of COVID-19, pre-pandemic healthcare may seem like a golden age.

https://www.economist.com/finance-and-economics/2023/01/15/the-global-health-care-collapse Global healthcare collapse | The Economist

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