Rationed Health Care and COVID-19

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Daniel Schludi via Unsplash

Autumn has arrived and rising hospital admission numbers has arrived with it. Looking around, I get the feeling that the pandemic issue has been reduced to just the issue of hospitals. The vaccinated are already ignoring the pandemic on a personal level – and the unvaccinated are too. (Un)vaccination has become a hard political stance and nothing can be done about it.

However, the vaccinated are concerned about the issue of hospitals. Because the vaccine won’t protect against hip replacements or inflamed appendixes. Yet hospitals are only the first level of the problem; patients with long COVID-19 will be filling the waiting rooms of specialists, primary care, and even spas in the coming months, if not years.

But this is not a problem specific to COVID-19, it has merely given us an unwanted tour of the world of the future. It’s a problem of the culture of entitlement and municipal grazing in healthcare. I pay €100 a month in levies (in any case, we have 3,000,000 state-insured people), so I am entitled to everything, everywhere, under any circumstances!

This was nicely illustrated to me by the discussion under the status of a Czech doctor. She was sniffling over a positive patient who had crowded into her outpatient clinic because he wanted to prescribe one more test, hoping to avoid quarantine. Some of the panelists were furious with her, saying that she was supposed to treat as the patient imagined!

We were experiencing this reality before COVID-19 as well – people calling for an ambulance to get an injection or to get them to a specialist as a priority, mothers fleeing to pediatricians because a child has got sand in his eye, or a tick needs to be removed. And it gets worse.

We’re getting older, we have more diseases, and we want to deal with more and more detailed ailments. Our grandfathers only went to the hospital with heart attacks or to die. Otherwise, they beat the doctors away with sticks. Today, our shoulder hurts when we hit a squash and we go to four specialists with it.

That’s okay, of course. Progress is moving forward and there is no reason not to expect better quality and availability of services. The problem, however, is when those expectations run up against a healthcare system that is de facto rationed. And the ration card doesn’t even say entitlement to two kilos of flour and one loaf of bread, I just says ‘food’. The result is lots of ration cards but not enough bread.

There are two ways to respond in parallel. One way is by expanding the supply. Here there is an obvious problem with the limited number of health workers. I am afraid that even a massive increase in health funding will not conjure up an additional health workforce.

There is still room for improvement in shifting and opening up competences (between medical specializations, from doctor to nurse or pharmacist, from nurse to clerk…). However, we are well-aware of this, and progress is happening very slowly.

It will therefore be necessary to think about the demand as well. People will have to think more consumeristically about access to health services. This means a clear definition of free services (entitlement), but also financial participation in those health services that are cost-bearing and do not mean a financial disaster for the patient.

Sharing the cost of treatment will affect people’s motivations, whether it is contracting COVID-19 or taking a risky skiing trip.

There will also need to be an opening up of the game for insurance products that are able to capitalize on improvements in the long-term health of the insured, for example in the form of limitedness or long-term benefits. But that would mean ditching the current premium tax system and moving to a form of nominal premiums.

The third way is just extreme paternalism, of which we are seeing an example today. Regardless of whether you are at risk, vaccinated or infected, your life is constrained by a complex set of rules, commands, and prohibitions.

Today, it’s blindfolds and closed gyms, but in the future it’s strictly regulated food choices, tobacco prohibition, tax breaks for skipping days, and fines for elevated cholesterol. Therefore, at the very least, we need to maintain the illusion of total access to health services.


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