Behind the Mask

Were we ready for round 2?

In the lull between waves one and two of the pandemic, our Behind the Mask surveys found that people were evenly split as to whether or not healthcare systems would be able to cope with another wave.

This uncertainty was generally evenly distributed across geographies, and among patients, payers and doctors, but some differences have emerged between individual groups. For instance, while US healthcare professionals (HCPs) are divided as to whether the healthcare system is ready for a second wave (53% said it was), 89% of US patients believed it was not, with half going so far to respond that their system is totally unprepared. We saw similarly differing viewpoints between payers in Germany and the US: while most German payers believe that the system is ready, those in the US took the opposite view.

The huge backlog of non-COVID-19 related patients (whose healthcare provisions have been disrupted since March) makes these differing views on preparedness especially challenging. While there has been a slight increase in the belief that ‘care is available’ between May and our most recent survey, results by country can vary significantly. For example, while not overwhelmingly positive, respondents from Germany suggest they are the most comfortable in terms of available care. In contrast, the UK’s National Health Service has been particularly badly hit: in fact, by August 20% of UK respondents felt that availability of care was extremely limited – that’s double the number of respondents in the US and Germany where just 10% felt the same way. When it came to considering if care was ‘completely open’, only 37% of German, 28% of US, and 18% of UK respondents felt that was true.

of all respondents to our August survey felt there was at least some aspect of care unavailable. Alarmingly this figure has increased from May when 61% of respondents felt the same.

Anticipating the next big hit

Our principal measure for the readiness of the healthcare systems we are examining is how available respondents believed that different types of care (e.g. chronic care, elective procedures, emergency care, etc.) were at the height of wave one and then during August period of respite. By comparing the answers of the different stakeholders, we can observe differences between those providing care and the expectations and experiences of those receiving care.

Overall, Germany and UK saw improvements in care provision, whereas the US remained largely unchanged. Sentiment across the board reports that two-thirds of respondents saw health systems as more open than not.

Payer positivity

Earlier in the pandemic, payers were by far the most positive group when considering the quantity of care available in their own systems. However, this confidence has crashed over time and with experience, falling from 35% believing that ‘all care’ was available to just 12% only 3 months later – a 66% decrease.

HCPs have acclimatised – but it is far from ideal

Conversely, HCPs’ confidence in their healthcare systems has significantly increased – while the change isn’t dramatic, they have become used to different ways of providing care and we see their belief that ‘patients are getting the care they need’ has risen from 50% to 60%. Such increases are having a significant effect on the wider teams:

“The teams were feeling very stretched and exhausted in terms of poor decisions at first. Non-clinical management have since learned from those mistakes (particularly around PPE supply), however this was at the detriment of morale. Patient care was affected for non-COVID patients as lists were cancelled and many still are not up and running”

Payer, UK, August 2020

The rude awakening for patients

Patients’ understanding of what has been happening in their doctors’ offices and hospitals has been quite different. Fed by a media narrative that championed doctors as ‘healthcare heroes’ (which less than a quarter of doctors feel actually been helpful) patients were initially confident that most care was available to them if needed. Indeed, in May twice as many patients believed that ‘all care’ was available compared to the HCPs expected to provide this care (29% vs. 15%). The ability to get any type of consultation at all initially created the illusion that things outside our homes had been running well.

“Video consultations have been a huge success! It is more convenient and easier when things aren’t necessary for an office visit.”

Patient with multiple conditions, USA, May 2020

However, as the months have worn on and patients have become exposed to different parts of the system their confidence has eroded. Disturbingly over 20% of patients now believe that there is almost no provision of care whatsoever. Market forces will tell you that if you do not get satisfaction from your investments (of money, time and effort) you will step away. Worryingly, this disengagement among patients will most likely lead to worse outcomes.

What to make of this?

From other Behind the Mask posts it is clear that doctors are doing their best and making do when it comes to new techniques like tele-visits – but these have not been universally embraced: while 77% of our US respondents have used video-consults, only 50% and 22% of those in the UK and Germany respectively have. It is clear more is needed to help.

It can be easy to get lost in all these data, but principally we must recognise that despite best efforts, a third of HCPs feel that care is more closed than open, and only a quarter believe that healthcare systems are back to their pre-pandemic excellence (which they were concerned about even before the emergence of COVID-19).

Both for the long term, and most importantly for the immediate term, ensuring that quality care remains available during the pandemic will continue to be critical to improving patient outcomes.