Unanticipated consequences: Lack of essential and nonessential patient care, furloughs of health care providers, and institutional financial losses

The COVID-19 pandemic caused large reductions in the use of medical services due to the cancellation of nonessential care and elective surgeries by providers and the avoidance of medical care by patients. As a result, health care providers sustained substantial financial losses. This resulted in layoffs and furloughs for health care personnel, adding economic stressors to health care providers who were already working under difficult conditions. The financing mechanisms for health care and structural features of the health care delivery system contributed to these large unanticipated consequences. Policy initiatives have the potential to reduce these adverse effects. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022. All rights reserved.

COVID-19 job and income loss and mental health: the mediating roles of financial assets and well-being and the moderating role of race/ethnicity

Prior research shows unemployment has a negative effect on mental health, yet whether this relationship is affected by financial factors is unknown. For example, having money in savings may mitigate the impact of job loss on mental health. We use structural equation modeling with data from the Socio-Economic Impacts of COVID-19 Survey with a nationally representative sample (N = 3,341) to examine COVID-19 related job loss and mental health as partially mediated by liquid assets and Financial Well-Being (FWB) and moderated by race and ethnicity as moderators. More than a quarter (28.34%) of participants said they experienced a job or income loss due to COVID-19, which was associated with greater psychological distress as measured by the PHQ-4. The structural model had excellent fit (RMSEA = 0.021);FWB partially mediated the relationship between job/income loss and mental health (p <.001), accounting for 49% of the total effect. However, liquid financial assets did not partially mediate this relationship. Black participants experienced very different direct and indirect effects. Social workers should assess and intervene concerning financial factors when individuals experience job loss. Job loss is different among Black individuals who face greater challenges related to structural racism yet also have greater resilience.

An Overview of the Algiers Subway Management Before and During the Covid-19 Pandemic to Avert Potential Financial Losses

The purpose of this paper is to assess the Algiers subway passengers' demand and to show its importance as mass transport means. Also, to carry out a forecast evaluation on the subway operation proposed by the Algiers Metro Company (EMA) for the year 2022, under the Covid-19 pandemic, to limit future financial losses and to respond optimally to passengers' demand. The methodology used in this research paper is based on the real Algiers subway passengers' demand between 2018 and 2021. In the first step, the consequence of the Covid-19 pandemic has been analyzed. Then, an evaluation of the Algiers subway operation before and during the pandemic has been done. As a result, the study demonstrated that the current operation is inefficient, which will lead to future financial losses. To avoid this last issue, the paper proposes some suggestions to adapt the subway capacity with the real users' demand. © 2022 The Authors. Published by ELSEVIER B.V.

Rehabilitations- und Vorsorgeeinrichtungen in der Corona-Krise: Situation und postpandemische Perspektive

Background During the early phase of the Corona pandemic (March to July 2020) rehab clinics were supposed to stop offering rehab treatment in order to be ready for admitting low-care patients from acute hospitals. On the other hand, acute care hospitals postponed elective interventions for the benefit of Corona patients and rehab patients denied treatment due to the fear of becoming infected. As a consequence a loss in revenue turns out while additional costs for infection protection management arose simultaneously. Methodology Aim of the study was to specify the economic risks of rehab facilities caused by the pandemic as well as the increasing medical requirements. Based on a structured questionnaire 97 rehab providers were polled referring to e. g. the „medical treatment situation", the „revenue development", the „cost pressure" and the „effects of supporting activities of the government". Results The revenue of rehab clinics collapsed intermittently up to 70 % compared to the previous year. Simultaneously, additional costs of 349 € per patient and employee per treatment cycle (21 days) accumulated due to decreed infection prevention arrangements. This unplanned cost burden corresponds roughly to 13 % of the revenue per case. The decline of rehab treatments under the pandemic will lead on to an exaggerated demand of medically necessary treatments in future. This congestion of non-performed rehab treatments is prognosed to exceed 20 % to 25 % of the rehab treatments performed in 2019. In 29 % of the facilities the shortage of personal protective equipment was associated with dysfunctional workflows and endangerment of patients suffering an infection. 71 % of the rehab facilities stated not to have benefitted from the procurement initiative of the German Ministry of Health. Discussion The Corona pandemic has reinforced the economic vulnerability of many rehab providers. This, due to additional costs for infection prevention activities, revenue losses owing to reduced occupancy and because of an investment bottleneck accumulated over years. Furthermore, the reimbursement system is complained not to cover the total costs of treatment in an economically sufficient way. Necessary investments in infection protection are a cost-driver but also lead to a factual impairment of treatment capacity. As a consequence, a piling up of medically essential rehab treatment is assumed to happen and will effect an increasing disease burden in the health system. Core Message The risk of insolvency has enhanced for rehab facilities due to the pandemic. Simultaneously, medical requirements have arisen and cost pressure has become more intensive. Because rehabilitation to play a pivotal role in public services the reimbursement system of the rehab sector is urged to be changed. One strong opinion requires to finance the costs of keeping rehab facilities. Indeed, this financing approach should be based on an assessment of the rehab demand. Furthermore, the operating costs are advised to be paid depended on medical quality, physical condition of the patient and the complexity of treatment. Zusammenfassung: Hintergrund Bereits in den ersten 6 Monaten der Pandemie erlitten die Rehabilitations- und Vorsorgeeinrichtungen massive Erlöseinbußen. Dies einerseits durch die Aussetzung von Heilverfahren und Nachsorgeangeboten sowie die Verpflichtung, im Bedarfsfall verlegbare Patienten aus Akutkrankenhäusern zu übernehmen;andererseits führte die Verschiebung elektiver Eingriffe zugunsten der prioritären Behandlung von Covid-19-Patienten in den Akuthäusern sowie die Angst von Reha-Patienten vor einer Infektion zu einem Nachfragerückgang. Demgegenüber entstanden erhebliche Zusatzkosten durch die Organisation infektionssicherer Arbeitsabläufe sowie die Beschaffung von Produkten der persönlichen Schutzausrüstung (PSA) auf einem überhitzten freien Markt. Das Insolvenzrisiko für die Reha-Einrichtungen erhöhte sich. Methoden Ziel der Studie war es, die ökonomischen und ablauforganisatorischen Konsequenzen sowie die Infektionsrisiken für Personal und Patienten einer Unterversorgung mit PSA-Produkten im Bereich der Rehabilitation zu ermitteln sowie die Effektivität staatlicher Eingriffe bei der Beschaffung von PSA-Produkten zu reflektieren. Durchgeführt wurde im Zeitraum 25. bis 28. Woche 2020 eine Online-Befragung unter 79 Einrichtungen mittels strukturiertem Fragebogen, u. a. spezifiziert nach den Erhebungsbereichen „Versorgungssituation bei PSA-Produkten", „Umgang mit PSA-Versorgungsengpässen", „Ertragssituation", „Zusatzkosten" und „Wirksamkeit staatlicher Hilfsmaßnahmen". In weiteren 18 Einrichtungen wurden Einzelinterviews zur Praxis des Pandemie-Managements vor Ort geführt. Die Erhebung wurde auf orthopädische, kardiologische und neurologische Einrichtungen konzentriert. Ergebnisse Der Umsatz der Einrichtungen ging um zeitweise bis zu 70 % gegenüber dem Vorjahr zurück, gleichzeitig erhöhten sich die Kosten für Infektionsprophylaxe um durchschnittlich 349 € pro Patient und Mitarbeiter pro Behandlungszyklus (21 Tage), was etwa 13 % des Fall-Erlöses bedeutete. Durch den Rückgang bei Patientenbehandlungen während der Pandemie baute sich ein Behandlungsstau auf, der zwischen 20 und 25 % der Reha-Leistungen des Jahres 2019 entspricht und die Krankheitslast im Gesundheitssystem zukünftig erhöhen wird. Der Mangel an Schutzausrüstung führte in 29 % der Einrichtungen zu erschwerten Arbeitsabläufen mit Infektionsgefährdung für Patienten und Mitarbeitende. Von der Beschaffungsinitiative des Bundesministeriums für Gesundheit fühlten sich 71 % der Einrichtungen nicht versorgt. Diskussion Die Corona-Pandemie hat die Anfälligkeit zahlreicher Reha-Einrichtungen für eine wirtschaftliche Schieflage verstärkt. Ursache dafür sind pandemiebedingte Zusatzkosten, Erlösausfälle aufgrund von Belegungsrückgängen und ein Investitionsstau in zahlreichen Einrichtungen. Notwendige Maßnahmen des Infektionsschutzes erhöhen nicht nur die Kostenbelastung, sondern vermindern faktisch die verfügbare Behandlungskapazität. Als Konsequenz ist ein Behandlungsstau zu erwarten, der mit erhöhter Krankheitslast im Gesundheitssystem verbunden sein wird. Kernbotschaft Das Insolvenzrisiko hat sich für Rehabilitations- und Vorsorgeeinrichtungen durch die Corona-Krise erhöht, gleichzeitig sind die Anforderungen an medizinische Qualität und Infektionsschutz ebenso wie die Vorhalte- und Behandlungskosten gestiegen. Eine Reform der Refinanzierung von Reha-Leistungen ist notwendig: Dies betrifft die Finanzierung von Vorhaltekosten von Reha-Einrichtungen als Teil der Daseinsvorsorge. Hier ist allerdings eine versorgungsstrukturelle und institutionenorientierte Bedarfsermittlung vorzuschalten, um Mitnahmeeffekten vorzubeugen. Weiterhin ist die Vergütung der Betriebskosten qualitäts- und aufwandorientiert am Krankheitsbild und am Patientenzustand vorzunehmen.

Gold demand reaches new heights

AFRICAN DEVELOPMENT : The World Gold Council's latest Gold Demand Trends Report revealed that annual demand (excluding OTC markets) has recovered many of the Covid-induced losses from 2020 to reach 4 021t for the full year in 2021.[1] Demand for gold reached 1 147t in Q4 2021, its highest quarterly level since Q2 2019 and an increase of almost 50% year-on-year, according to the World Gold Council. Gold bar and coin demand rose 31% to an 8-year high of 1 180t as retail investors sought a safe haven against the backdrop of rising inflation and ongoing economic uncertainty caused by the coronavirus pandemic. Meanwhile, the World Gold Council's data series reported outflows of 173t in 2021 from gold-backed ETFs as some more tactical investors reduced hedges early in the year amid Covid vaccine rollouts, while rising interest rates made holding gold more expensive