COVID Has Been a Challenge in Healthcare – Don’t Expect It To Get Better Anytime Soon

The pandemic has surface a number of foundational problems in US healthcare, including the fragile nature of the healthcare supply chain, the high cost of medical devices, the paper-thin operating margin of many hospitals, and the availability of qualified staff. Add to this the climate crisis and the critical role of healthcare in solving it – and we have a confluence of challenges that need to be addressed – fast and through both wide and deep changes. Many of these are being addressed politically as well as in hospital administration – we have learned the lesson, but the suffering is far from over. Many of the pandemic-triggered challenges will not be solved in the short run and are likely to make 2022 at least as difficult for healthcare as 2020 and 2021 were.

According to Modern Healthcare, hospital operating margins dropped by 18% between August and September 2021. We saw the same margin decline earlier in the pandemic: A disastrous combination of reduced volumes (because patients stay away from or delay especially the highly profitable elective surgeries) and higher costs (due to pandemic related activities). With COVID whipsawing between peaks and momentary recoveries from state to state – and vaccination numbers still embarrassingly low, there is not much reason to believe that we have seen this combination for the last time. One thing is certain: Hospitals have to find a way to sustain their elective surgeries. Certainly, banning these was a bad decision, but ensuring that patients feel comfortable about going to the hospital is a different challenge altogether.


Hospitals have to find a way to sustain their elective surgeries.


The climate crisis: Hospitals are responsible for more than 8% of all US greenhouse gas emissions, and reducing emissions in hospital operations has been the focus for most of healthcare’s attempt to reduce environmental impact. This is turning out to be – far from – enough. Greenhouse gas emissions from the hospital are a great staring point, but they are so-called scope 1 emissions and fail to address what is happening in the supply chain (that’s scope 3 – emissions not directly controlled by the hospital). In fact, 80% of healthcare emissions come from medical devices, pharmaceuticals, food services, etc. This is far more difficult to address, but healthcare is not effectively responding to the call for greener solutions until it addresses it’s supply chain. 2022 is going to focus even stronger on this.

The pandemic showed us how fragile US hospitals are financially. Most simply cannot handle small demand fluctuations. Prices on, for example, medical devices, simply have to come down. Any other scenario is unsustainable. We are back to, “It’s the Prices, Stupid” – we just spend too much on healthcare in the US, and to fix that, prices have to come down. And all players in healthcare have to participate. Two notable players, who have largely avoided attention, although they need to be part of the solution: Payers and manufacturers. Manufacturers are foreseeing price increases even higher than usual due to their supply chain issues, so price reductions are not coming from that direction any time soon.


...we just spend too much on healthcare in the US, and to fix that, prices have to come down.


One of the perhaps biggest challenges to post-COVID US is neither costs nor the environment. It’s staffing. Burnout has plagued professions such as technologists, nurses, and even doctors since the height of the pandemic more than a year ago. Many have simply left their profession. Labor shortages are driving up costs significantly and making it harder for hospitals to serve their patients with qualified staff. Going back to the jigsaw of COVID – this will not get better any time soon – in fact, it will probably get worse. Add this to the lower volume-higher cost issue, and we have a recipe for disaster: Lower operating margin and less ability to deliver care.

The point is, we are in a “build-the-plane-while-we-fly-it” situation: We must repair US healthcare, and we must do it while we are not yet out of the pandemic – because its effects will continue to plague the sector for years, and there is no time to wait in addressing fundamental issues.


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