Dr. Vikas Saini: COVID-19 could be an opportunity to fix our fragmented health care system

Many people observing the COVID-19 pandemic have compared it to a war, in terms of the danger to the public and the commitment in resources we will need to win. To Dr. Vikas Saini, president of the Lown Institute, this metaphor is apt, but needs to be taken one step further.

“Imagine that we are fighting a war, but we have 6,000 different military organizations.”

Dr. Vikas Saini

“Imagine that we are fighting a war, but we have 6,000 different military organizations, with little coordination between them. That’s what our health care system is like right now,” said Saini. “Hospital clinicians and other front-line workers are the soldiers. But they are fighting without equipment to protect themselves, and they don’t have the ability to communicate across the field.”

Fault lines in the system

The COVID-19 pandemic has uncovered “fault lines” in the health care system that need to change, and one of these major fault lines is fragmentation. Managing separate providers, insurers, and electronic health records, is often confusing and time-consuming for both patients and providers.

Now, the pandemic is showing how important a coordinated health care system is in a public health emergency. While other countries such as South Korea and Australia have mounted massive testing campaigns to be able to “trace, test, and treat” coronavirus effectively, hospitals in the U.S. are only testing a fraction of symptomatic patients because the tests simply are not available.

“The testing infrastructure we need requires community-level modeling. If the Centers for Disease Control and Prevention had a more robust monitoring and surveillance function, we could have been testing everyone as soon as the first case of community transmission arrived,” said Saini.

Disturbing shortages

From intensive care unit beds to protective equipment to ventilators, our system is facing disturbing shortages without a unified response. Some areas of the U.S. have as many as one ICU bed per 100 elderly residents, while more than half of the counties in America have no ICU beds at all. This disparity arises not from differing medical needs but from a market-based system in which hospitals with more ICU beds cluster in higher-income areas.

Similarly, while some hospitals are scrambling to treat COVID-19 patients without enough protective gear, other hospitals are still performing elective surgeries. With better planning and coordination, hospital beds and supplies could be marshaled and directed where they are most needed.

In the short-term, we need a plan to mobilize as many of our resources as possible to mitigate the harm of this pandemic. In the long-term, “we need to build the infrastructure to be able to act on a local level before problems become emergencies, rather than react when it is already too late,” said Saini.