Let’s Use the Pandemic to Change Mental Health Care for the Better

MEDICAL ECONOMICS

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The COVID-19 pandemic should have us reflecting on the state of our health care system as well as embarking in a national dialogue on what type of system we want for this country and what investments we need to attain that vision.

So many questions arise when considering the pandemic: Why were we so ill prepared to mount a national response? Why are health care costs so high? Why does so much of the population have such poor access to basic care, with racial and economic disparities so pronounced? What should be our focus going forward? Here are a few thoughts and observations as we start examining some of the issues and begin that dialogue.

Clearly, health care delivery has undergone massive shifts over the past decade, but have those shifts brought us closer to a better system of care for our country? Looking back to 2000, it is interesting to note that only a handful of the Fortune 500 companies were involved in health care. Now 40 of them, including 6 of the top 10, have health care as a line of business.

This massive shift of major corporate interest into health care clearly signals that this realm represents the potential for big profit. The question that remains is whether that shift has, in fact, resulted in better care at a lower price—either for the country as a whole or for the patients and businesses who pay the bills.

Many of the payment reforms implemented by the Centers for Medicare & Medicaid Services and now taken up by private payers—the reforms that promise to make providers more accountable and share more of the financial risk—have hastened this massive consolidation of the health care industry. This consolidation has occurred mainly among health care systems and the insurance industry as they have added vertical integration to their strategic plans. How has that changed the delivery of health care? Is care now more accessible, more affordable, and of higher quality, or have these reforms reduced access and competition and increased fragmentation of care?

As our nation fights its way out of this pandemic, we should examine how we can better prepare for future national health emergencies. Clearly, a greater investment in public health and basic preparedness is essential. However, several aspects of our system need to be separately examined.

Health care—along with good schools, grocery stores, and other locally operated basic services— sustains the economy of many small towns. This is evident in areas ranging from the Alaska frontier to the hearts of our inner-city communities. It is the norm for other industrialized countries.

Much has been written about the closing of our rural hospitals, but it may be worth examining more closely the effect of the loss of independent physicians and pharmacies as well, not just as health care providers, but also as small businesses that contribute to the community as leaders and employers.

What is the effect of the purchase or consolidation of health care resources? Do these changes sustain or grow the local economy by bringing more jobs and services, or do they, instead, just slow that economy’s decline as leaders and decision-making move to a distant corporate location, services are streamlined and consolidated elsewhere, and participation in local community activities is lost? Are we seeing the “Walmart effect” on locally owned health care businesses?

Now that the experience of the COVID-19 pandemic has shown the effectiveness of working from home, the fact that living close to work is no longer necessary may represent a new dawn for small towns, if we can reexamine how to make them viable communities again with the health care, education, and services people need and want.

Dr Dobson is a family physician and Editor-in-Chief of Medical Economics®. ❒

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What do you think? How can we learn from this pandemic and improve health care? Write to us at PTEditor@mmhgroup.com.