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COVID-19: How has the US healthcare system changed since H1N1?

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Crystal Yednak Senior Manager, Health Research Institute, PwC US March 06, 2020

Should the coronavirus outbreak escalate to a pandemic, it would hit a healthcare system that has evolved in a number of ways from the one that responded to the 2009 H1N1 pandemic.

From preparedness efforts to where care is delivered, market concentration to insured rates, the industry has been reshaped in many ways over the past decade, including the rise of retail health and urgent care centers, hospitals shifting from inpatient admissions toward outpatient services, and more hospitals absorbed into larger health systems.

The US has fewer hospital emergency departments than it did 10 years ago, but at the same time it has seen an increase in visits to those emergency departments, according to the American Hospital Association’s TrendWatch Chartbook 2018.

Meanwhile, growth in urgent care centers has exploded by roughly 43% from 2013 to 2018, according to the Urgent Care Association. From 2007 to 2016, urgent care centers showed an increase in claim lines of 1,725%, according to a 2018 FAIR Health report based on the nonprofit’s database of 25 billion private healthcare claims. Notably, the report found that in 2016, the top diagnostic category for retail clinics and urgent care centers was for acute respiratory infections.

From the consumer perspective, the landscape is different as well. With the passage of the Affordable Care Act, more consumers are insured than in 2009, as rates of uninsured dropped significantly in the years following the implementation of the ACA, but those rates have ticked up since 2017.

HRI research shows consumers are feeling the pain of increasing healthcare costs, especially with average deductibles for employer-sponsored plans tripling between 2008 and 2018. Many consumers are seeking care in settings outside the traditional doctor’s office.

A 2018 HRI consumer survey showed that of those with employer-based insurance, 60% said they have received care in an urgent care center, 25% in a retail health clinic and 11% by video visit.

HRI impact analysis

In this 2020 landscape, providers are preparing to respond based on lessons learned and the forces shaping the market. As patients experience flulike symptoms, telehealth could play a role in keeping those people out of emergency department waiting rooms, where they could further spread the virus.

Use of telehealth has grown from 35% of hospitals in 2010 to 76% reporting fully or partially implementing a telehealth system in 2017, according to the American Hospital Association. The trend toward market consolidation may mean that standardized structures and procedures are in place in these large health systems, which could be helpful to sharing crucial information during an outbreak.

Hospitals do have fewer inpatient beds, which could affect the ability to accommodate a sudden influx of critical patients, especially if that were to coincide with flu season hospitalizations.

Retail health clinics and urgent care centers could emerge to play a role in helping noncritical patients deal with their symptoms during an outbreak, reducing the burden on other healthcare providers and freeing them to deal with more serious patients.

2009 report from the HHS Office of Inspector General (OIG) on hospital preparedness for pandemic flu showed hospitals having difficulties implementing electronic systems to track available hospital beds and medical equipment during an emergency. Since 2009, providers have made strides in health information technology and implementation of electronic health records. While progress has been made in hospital data systems, major obstacles still exist for data sharing across the healthcare system.

Providers have invested in preparedness since H1N1 in 2009, but when the Ebola virus showed up in the US in 2014, 71% of hospital administrators said their facilities were unprepared to deal with it, according to a 2018 OIG report.

But after that scare, many went to work updating emergency plans, training staff, buying supplies and conducting drills—92% of hospitals ordered extra supplies such as protective equipment. By 2017, only 14% said they were still unprepared for emerging infectious disease. Many administrators also added that an outbreak would strain their resources while expressing concern about sustaining that preparedness as the immediate fear fades. 

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Trine K. Tsouderos

Business Insights, Sectors Leader and Health Research Institute Leader, PwC US

Tel: +1 (312) 241 3824

Crystal Yednak

Senior Manager, Health Research Institute, PwC US

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