We knew that healthcare as a service is costly, but gives us years of life in good health in return, delivered by hospitals that are increasingly run like efficient factories. Healthcare used to be something local, national at best. Covid-19 changed all of that.
Every minister of health knows the dilemma: economists tell us that each dollar spent on healthcare delivers far more than a dollar’s worth in quality of life in return. So in order to improve the life of citizens, one can just increase the healthcare budget. However – although health is our greatest possession – there is never enough money to buy all the healthcare we would like. This made healthcare the ultimate luxury good: governments could seldom earn money through healthcare investments.
While we are nowhere near the end of the pandemic, Covid has already taught us that our healthcare system is the only thing standing between us and an economic downfall. We found ourselves spending all the money we had, or could borrow, on tests, emergency clinics, mouth masks and sanitizing gel. Hopefully we’ll learn from this pandemic to prevent the next one. A pandemic that might just as well be much more infectious (like measles), much deadlier (like Ebola), or one for which finding a treatment or vaccine will take decades (like HIV). The threat of the next pandemic should be incorporated into our healthcare budgeting: we can’t afford healthcare systems that can’t stop the next outbreak.
Speaking of healthcare workers, we used to view working in healthcare as something between a noble calling and a techy career with lots of customer interaction. Hospitals are increasingly focusing on efficiency, factory-like process management leading to healthcare workers and healthcare infrastructure being used to the max of their capacity. When Covid appeared, healthcare workers discovered that we expected them to go and stand in harms way for us. Somebody had to help the Covid patients at the ICUs, spreading life-threatening viruses with every breath, and healthcare workers stepped up to the plate, even at places where there wasn’t enough protective gear available.
Suddenly, doctors and nurses became similar to firefighters and soldiers – but without perks like hazard pay or early retirement.
Nurses are already scarce, given the fact we’ve got aging populations in many countries. The prospect of being hurled into the next pandemic without proper protection might not help the recruitment process. To prevent a future pandemic staff shortage, we would need to recruit and train a lot of nurses, put them on standby for years, ready to jump in in case of a pandemic. However, it’s questionable if this will align with the professional ambitions of nurses: I don’t know any nurse who would be willing to prepare for a crisis that may take decades to arrive.
Another lesson several hospitals learned is the value of unused capacity. A smaller hospital building, tightly wrapped around its core processes, was the pride of every hospital director. During the first wave of the pandemic however, an unused hospital wing waiting for demolition suddenly became a precious asset for Covid wards. And even now, hospitals are scrambling for space to deliver socially-distant care that doesn’t go well with crowded hallways and packed waiting rooms. The trend of shrinking hospitals will be reversed towards broad corridors and excess capacity. The bottom line is that we will be spending a lot of our valuable healthcare budgets on overcapacity and stockpiles.
We used to think about healthcare on a national level: a country can decide how healthy it wants to be by choosing to spend its wealth on healthcare – or not. Healthcare spending per capita in the USA is about 500 times higher than, for example, the Democratic Republic of Congo can afford. The next pandemic may just as easily originate there as anywhere else. The Covid virus doesn’t discriminate much, so it seems: it mingles in all circles, seemingly unhindered by travel bans or political optimism.
This raises the question of where to invest the next healthcare dollar. And we do have a choice here. We can train an army of backup nurses and expand hospitals, stockpile equipment, tests and consumables for every pandemic thinkable. Or we might have to accept that we will inevitably get affected by the next one, even if we prepare perfectly at country-level.
The alternative is to invest in the weakest link of our global healthcare system: the Global South. Developmental aid in healthcare can yield more healthy life years than the same budget could if it were spent stockpiling. And even if that aid would purely be spent on healthcare improvements protecting donor countries against pandemics (e.g. sanitation, vaccination, diagnostics, primary health care, global watchdogs like the WHO), citizens of developing countries would benefit greatly. The same rural African doctor, donor-funded to spot an Ebola-outbreak early, can make an enormous difference in the quality of life of her patients.
Healthcare might never be the same again. Maybe it was like this all along, but we were lulled asleep thinking pandemics were something of the past. In any case, it is clear that we will have to invest in healthcare, and we now have the choice to either stockpile mouth masks and rely on isolation, or invest in the global healthcare system and help people at the same time. The WHO knows what we have to do; the only thing lacking is countries serving their self-interest to make this happen.