Economics of a Health System's Direct-to-Consumer Telemedicine for Its Employees

Am J Manag Care. 2023;29(6):In Press _____ Takeaway Points The value of direct-to-consumer (DTC) telemedicine services offered by academic health systems is understudied. * DTC telemedicine services for low-acuity or minor illnesses are increasingly offered as an employee benefit, but any per-episode unit cost advantage may be offset by overuse of care. * DTC telemedicine staffed by an academic health system and offered to its employees resulted in lower per-episode unit costs for care within 7 days and only marginally increased the use of services. * DTC telemedicine staffed by an academic health system and offered directly to employees was cost-saving. _____ Employers in the United States have increasingly been offering a direct-to-consumer (DTC) telemedicine benefit for low-acuity or minor illnesses to their employees.1-3 By 2021, more than 95% of employers with 50 or more employees provided some coverage for DTC telemedicine in their largest health plan;more than 75% felt that offering telemedicine was important and nearly 20% either limited or eliminated cost sharing for telemedicine.4 Despite these trends among general employers, few health systems have directly provided DTC telemedicine to their own employees. [...]because these services are easy to access (often available immediately, around the clock, and without travel), they may induce overuse of care, especially for self-limited conditions such as viral upper respiratory infections for which the alternative to in-person care is no care at all, thus increasing the overall cost of care.5-11 Telemedicine will save money relative to in-person care if any unit price advantages are not overwhelmed by the increased use of care overall, induced by its convenience. Employers provide health insurance coverage for 158 million Americans or nearly 50% of the population. Since the COVID-19 pandemic began, telemedicine has represented a significantly larger portion of all medical claims—consistently more than 5% of all medical claims by mid-202112-15—and the estimated value of the global telemedicine industry is projected to reach a quarter of a trillion dollars by 2024.13 Yet, the future of telemedicine remains undetermined with reimbursement rates in debate,16-18 driven in large part because its economic value is understudied and uncertain. Penn Medicine is self-insured and more than 95% of employees use its only employer-sponsored plan—a preferred provider organization (PPO) plan—rather than insurance obtained individually or through a family member. Since 2017, these PPO-insured employees have been offered Penn Medicine OnDemand,19 a 24/7 DTC telemedicine benefit to employees and their adult (≥ 18 years) dependents.

Area-specific covid-19 effects on health services utilization in the Democratic Republic of the Congo using routine health information system data.

BACKGROUND: Since March 2020, the COVID-19 pandemic has shocked health systems worldwide. This analysis investigated the effects of the pandemic on basic health services utilization in the Democratic Republic of the Congo (DRC) and examined the variability of COVID effects in the capital city Kinshasa, in other urban areas, and in rural areas. METHODS: We estimated time trends models using national health information system data to replicate pre-COVID-19 (i.e., January 2017-February 2020) trajectories of health service utilization, and then used those models to estimate what the levels would have been in the absence of COVID-19 during the pandemic period, starting in March 2020 through March 2021. We classified the difference between the observed and predicted levels as the effect of COVID-19 on health services. We estimated 95% confidence intervals and p-values to examine if the effect of the pandemic, nationally and within specific geographies, was statistically significant. RESULTS: Our results indicate that COVID-19 negatively impacted health services and subsequent recovery varied by service type and by geographical area. COVID-19 had a lasting impact on overall service utilization as well as on malaria and pneumonia-related visits among young children in the DRC. We also found that the effects of COVID-19 were even more immediate and stronger in the capital city of Kinshasa compared with the national effect. Both nationally and in Kinshasa, most affected services had slow and incomplete recovery to expected levels. Therefore, our analysis indicates that COVID-19 continued to affect health services in the DRC throughout the first year of the pandemic. CONCLUSIONS: The methodology used in this article allows for examining the variability in magnitude, timing, and duration of the COVID effects within geographical areas of the DRC and nationally. This analytical procedure based on national health information system data could be applied to surveil health service disruptions and better inform rapid responses from health service managers and policymakers.

Psychiatric emergencies among urban youth during COVID-19: Volume and acuity in a multi-channel program for the publicly insured.

This study sought to characterize changes in the utilization of psychiatric emergency services among children and adolescents during distinct phases of 2020, as compared with prior years. We conducted a retrospective review of electronic health records from January 2018 through December 2020 that included all encounters made by patients under age 21. We then analyzed data for the 15,045 youth psychiatric encounters during the study period. Encounter volume in 2020 was significantly lower than prior years in March through May (IRR, 0.44; 95% CI, 0.40-0.49), May through July (IRR, 0.63; 95% CI, 0.56-0.71), and October through December (IRR, 0.76; 95% CI, 0.70-0.83). Encounters for youth with primary psychotic disorders remained at typical levels throughout 2020. Among older adolescents and youth with anxiety disorders, pervasive developmental disorders, and substance use disorders, encounter volume was significantly lower than prior years only during the initial lockdown period. There were significantly more encounters than normal conducted by mobile crisis units, including via telehealth, in July through October (IRR, 1.31; 95% CI, 1.06-1.62) and October through December (IRR, 1.28; 95% CI, 1.05-1.55) of 2020. Differences in patterns of encounter volume based on sociodemographic and clinical characteristics highlight subgroups of youth who may have been particularly vulnerable to acute mental health problems during periods of social distancing and isolation. Proactive efforts to engage vulnerable youth in outpatient treatment during periods of increased infectivity may help prevent increasing symptoms from reaching the point of crisis.

Phase 3 Clinical Trial of Metformin for Treatment of COVID-19 in Adults With Overweight and Obesity

Background: Early treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to prevent progression to severe coronavirus 2019 disease (Covid-19) is an important component of the comprehensive response to the Covid-19 pandemic. Persons with overweight and obesity are at increased risk of poor short- and long-term sequelae of SARS-CoV-2 infection. Prior to its use for diabetes, metformin was used as an anti-viral medication. Methods: The COVID-OUT trial was a phase 3, factorial randomized, double-blinded placebo-controlled trial in non-hospitalized adults aged 30-85 years with overweight or obesity (n=1280) testing metformin immediate release titrated to 1500 mg/day, ivermectin 430 mcg/kg/day for 3 days, or fluvoxamine 50 mg twice daily within 3 days of confirmed SARS-CoV-2 infection and fewer than 7 days of symptoms. The primary endpoint was progression to severe Covid-19, defined as: hypoxia <=93% on home oximeter or healthcare utilization for Covid-19: emergency department visit, hospitalization, or death. Analysis was adjusted for SARS-CoV-2 vaccination, other trial medications, and used concurrent controls only. Results: The median age was 46 years, 54% female, 52% vaccinated, median body mass index (BMI) was 30 kg/m2 (interquartile range, 27 to 34 kg/m2). The adjusted odds ratio for the primary endpoint was 0.84 (95% confidence interval (CI), 0.65 to 1.09) for metformin;1.04 (95%CI, 0.74 to 1.44) for ivermectin;and 0.90 (95%CI, 0.63 to 1.30) for fluvoxamine. In pre-specified secondary analysis of the healthcare utilization components of the composite outcome, metformin had lower odds of emergency department visit, hospitalization, or death: 4.3% (27/627 with complete follow-up) versus 7.5% (47/628 with complete follow-up);adjusted odds ratio 0.60 (95%CI, 0.37 to 0.98). Conclusions: No medication reached significance for the primary endpoint. Participants receiving metformin had a 40% lower odds of emergency department visits, hospitalizations, or death due to Covid-19 (secondary endpoint). Available, inexpensive outpatient treatment with few contraindications is still needed to prevent worsening health disparities from Covid-19. Anti-viral properties of metformin could contribute insights into whether its anti-adipokine actions and associations with chronic disease outcomes are due to effects on the virome.

Trends in Well-Child Visits and Routine Vaccination among Children of U.S. Military Members: An Evaluation of the COVID-19 Pandemic Effects.

The COVID-19 pandemic has drastically impacted administration of healthcare including well-child visits and routine vaccinations. The purpose of this study was to determine the impact of COVID-19 pandemic disruption on childhood health maintenance: well-child visits and scheduled vaccinations. We queried the TRICARE Management Activity's Military Health System (MHS) database for outpatient well-child visits and vaccinations for all children 0 to 23 months of age eligible for TRICARE healthcare. The median rate of well-child visits, during the COVID-19 period (March 2020-July 2021), was significantly declined for all demographic groups: all ages, parental military ranks, sex, and regions as compared to the pre-COVID-19 period (February 2019-February 2020). Similar to rates of well-child visits, the rate of vaccinations declined during the COVID-19 period as compared to the pre-COVID-19 period for all demographic groups, except children 12-23 months. Rates of well-child visits for military dependent children under 2 years of age were decreased during the 16 month COVID-19 period, with large increases seen in the first 2 months of the pandemic; the consequences of missed well-child visits and vaccination are unknown.

'I Didn't Know Where to Go': A Mixed-Methods Approach to Explore Migrants' Perspectives of Access and Use of Health Services during the COVID-19 Pandemic.

The COVID-19 pandemic put pressure on health systems, affecting populations' use of health services, especially those experiencing increased difficulties in healthcare access, as some migrant groups. This study aimed to investigate access and use of health services during the COVID-19 pandemic among migrants in Portugal. A mixed-methods approach was used. A community-based cross-sectional survey was conducted involving migrant communities residing in the Lisbon Metropolitan Area. Analyses of a subsample of participants (n = 929) examined factors associated with perceived worsening of access to health services during the pandemic. Semi-structured interviews with 14 migrants were conducted and thematically analyzed to further understand experiences and difficulties in health services' use. Around 44% of surveyed participants reported worsening of access to health services since the pandemic, more frequently women, those with lower income, and those who perceived being at moderate or high risk for COVID-19 infection. Digital change in services and lack of formal and informal support during lockdowns were highlighted by interviewers as main barriers in access to healthcare for migrants. The pandemic renewed concerns about inequalities in healthcare access among migrants. It is key that in following years health systems are able to address the potential accumulated burden of disease.

Utilization of health services among the elderly in Iran during the COVID-19 outbreak: A cross-sectional study.

Background and Aims: Elderly people are potentially vulnerable with a higher need for health services, and utilization of Essential Public Health Services (EPHS) among this group is of high importance. This study aimed to examine the utilization of health services among the elderly in Iran during the coronavirus disease 2019 outbreak. Methods: This was a cross-sectional study conducted in 21 public health centers in Sirjan, Southern Iran, from May to December 2020. A total of 420 elderly patients were selected through a systematic random sampling method. Data were collected using a questionnaire and were analyzed using SPSS v22.0. The binary logistic regression was used to examine the effect of demographic, socioeconomic and morbidity status on inpatient and outpatient healthcare utilization. Results: Our results showed that 56% of the elderly had a history of hospitalization during the last year. Although 60% of the elderly reported they had a perceived need for outpatient services, only 49% of them reported that they utilized outpatient services. 51% and 35.5% of the elderly reported that their inpatient and outpatient costs were covered by health insurance, respectively. Others reported their health spending was financed through out-of-pocket payments. Male gender aged 80 and above, urban residents, higher socioeconomic and supplemental insurance coverage were associated with an increase in health services utilization. The elderly with Cancer, mental disorders, kidney disease, and cardiovascular diseases (CVDs) were more likely to be hospitalized. Conclusion: There were demographic and socioeconomic inequalities in health services utilization among the elderly. Therefore, appropriate interventions and strategies are needed to reduce these inequalities in health services utilization among the elderly. In addition, given that the hospitalization rate was significantly higher among the elderly with chronic diseases than those without, it is crucial and necessary to take interventions to reduce the burden of chronic diseases in the future.

Perception of Mental Health on Christian College Campuses: A Case Study

The perception of mental health directly impacts an individual's acceptance and utilization of counseling services. Mental health challenges are increasingly common among college students. The purpose of this case study is to examine the perception of mental health and the receptiveness to receiving mental health services among Christian college students. This study surveyed both professors and students from a Christian college in Central Pennsylvania. The two key themes that emerged from this study were a perceived stigma attached to mental health challenges and receiving mental health services and a lack of support from the Christian community. The survey results inform the recommendations including expanding education surrounding mental health and mental health services, accessibility of mental health services, and destigmatizing mental health.

Dark side consequences of cyberchondria: an empirical investigation

Purpose>Cyberchondria refers to the repeated and excessive search for health-related information online, associated with increased health anxiety. This paper utilizes the protection motivation theory to investigate the negative behavioral consequences of cyberchondria that pose health risks to users, such as trust in the physician, propensity to self-medicate, and therapy compliance.Design/methodology/approach>The data for the study were collected from a sample of 317 participants in India using an online survey and form. The analysis was conducted using structural equation modeling.Findings>Cyberchondria negatively affects the trust in physician and positively affects the propensity to self-medicate. Trust in physician negatively affects the propensity to self-medicate and positively affects therapy compliance. Furthermore, trust in physician partially mediates the relationship between cyberchondria and the propensity to self-medicate and completely mediates the relationship between cyberchondria and therapy compliance. Cyberchondria has no direct significant effect on therapy compliance.Research limitations/implications>Researchers need to examine other behavioral or psychological factors affected by the reduced trust in physicians due to cyberchondria.Practical implications>Physicians and health care providers should refocus on patients with cyberchondria and regain their trust through quality interactions and services. Policymakers may consider regulating online health information publication to set the standards of information quality and source. Websites and platforms publishing health information online should distinctly label verified information.Originality/value>This study investigates the damaging effects of cyberchondria's behavioral consequences that pose health risks to users.

Factors associated with telehealth use among adults in the United States: Findings from the 2020 National Health Interview Survey.

INTRODUCTION: During the COVID-19 pandemic, health care shifted to virtual interactions with health professionals. The aim of this study was to examine the determinants of telehealth use in a nationally representative sample of the United States adult population. METHODS: The study used data from the 2020 National Health Interview Survey of 17,582 respondents aged ≥18. Andersen's model of health services utilization was employed to examine predisposing, enabling, and needs factors associated with past-year telehealth use. Multivariable logistic regression was conducted to examine statistical associations. RESULTS: 32.5% of adults (n = 6402; mean age 51.6, SE = 0.4) reported telehealth use. Predisposing factors: Women and married/partnered adults and those with higher levels of education had greater odds of using telehealth. Adults living in Midwest and South and adults living in medium-small and non-metropolitan areas had decreased odds of using telehealth. Enabling factors: Income and having a usual source of care were positively associated with telehealth use. A negative association was found for those with no insurance and telehealth use, whereas a positive association was found for military insurance. Needs factors: Odds of using telehealth were increased for adults who had well-visits and ER visits in the past 12 months. Mental health services quadrupled the odds of telehealth use. Odds of using telehealth increased with each additional chronic disease, including COVID-19. CONCLUSION: There are disparities in telehealth use according to sex, education, rurality, access to care, and health needs. Tackling these disparities is pivotal to ensure barriers to telehealth use are not exacerbated post-pandemic.

Access to health care among racialised immigrants to Canada in later life: a theoretical and empirical synthesis

Evidence that immigrants tend to be underserved by the health-care system in the hosting country is well documented. While the impacts of im/migration on health-care utilisation patterns have been addressed to some extent in the existing literature, the conventional approach tends to homogenise the experience of racialised and White immigrants, and the intersecting power axes of racialisation, immigration and old age have been largely overlooked. This paper aims to consolidate three macro theories of health/behaviours, including Bronfenbrenner's ecological theory, the World Health Organization's paradigm of social determinants of health and Andersen's Behavioral Model of Health Service Use, to develop and validate an integrated multilevel framework of health-care access tailored for racialised older immigrants. Guided by this framework, a narrative review of 35 Canadian studies was conducted. Findings reveal that racial minority immigrants’ vulnerability in accessing health services are intrinsically linked to a complex interplay between racial-nativity status with numerous markers of power differences. These multilevel parameters range from socio-economic challenges, cross-cultural differences, labour and capital adequacy in the health sector, organisational accessibility and sensitivity, inter-sectoral policies, to societal values and ideology as forms of oppression. This review suggests that, counteracting a prevailing discourse of personal and cultural barriers to care, the multilevel framework is useful to inform upstream structural solutions to address power imbalances and to empower racialised immigrants in later life.

Health Care Utilization among Medicare Beneficiaries with Diabetes during the COVID-Pandemic

The COVID-pandemic has abruptly impacted health care systems. Using data from Medicare claims we examined the pandemic-related changes in health care utilization among fee-for-service beneficiaries with diabetes. We included persons with diabetes who were aged ≥ 67 and enrolled in both Part A and B programs for all months of the index year and the previous year. Diabetes was identified by having at least one inpatient or two outpatient claims that were diabetes related. We considered utilization by setting (acute inpatient, emergency room, hospital outpatient [HOP], physician office, and ambulatory surgery center [ASC] procedures) and by media (telehealth and in-person) . Utilization was measured as per person use of each type of health care service for each month from Jan. 2018 to Jun. 2021. We quantified the changes in utilization with a fixed-effect model for all post-pandemic months (3/2020-6/2021) and three phases (3/2020-5/2020;6/2020-12/2020;and 1/2021-6/2021) . We found that health care services usage by setting was 8% to 18% lower than the pre-pandemic level (Table) . Phase 1 had the largest decrease in utilization. In phase 3, utilization was still lower than the pre-pandemic level for most service types, except HOP visits and ASC procedures. We also found a large increase in telehealth visits, although the increase was not large enough to compensate for the decrease in in-person office visits.

Confronting and Ending Food Insecurity During and Beyond the Pandemic: A Public Health of Consequence, July 2022

[...]we have substantial information across multiple disciplines on the drivers and consequences of food insecurity. According to the US Department of Agriculture's Economic Research Service, food insecurity among US households with children increased from 13.6% in 2019 to 14.8% in 2020, and this increase was greater in communities of color.1 For example, Dubowitz et al. found that low-income African Americans residing in food desert neighborhoods experienced greater increases in food insecurity between 2018 and 2020, from 20.7% to 36.9%, compared with the general population.2 The impact of food insecurity on health care utilization during the pandemic is equally disturbing. [...]supporting local farmers markets that accept produce vouchers will, in addition to increasing access to food banks and mobile pantries for older adults and individuals with limited mobility, enable local communities to meet and sustain local needs in providing healthy produce.

Extending Postpartum Medicaid Beyond 60 Days Improves Care Access and Uncovers Unmet Needs in a Texas Medicaid Health Maintenance Organization.

Under longstanding federal law, pregnancy-related Medicaid coverage is only guaranteed through 60-days postpartum, at which point many women become uninsured. Barriers to care, including lack of insurance, contribute to maternal mortality and morbidity. Leveraging the Families First Coronavirus Response Act, a federal law requiring that states provide continuous coverage to Medicaid enrollees during the COVID-19 pandemic as a condition of receiving enhanced federal financial support, we examine whether postpartum women seek additional care, and what types of care they use, with extended coverage. We analyze claims from the Parkland Community Health Plan (a Texas Medicaid Health Maintenance Organization) before and after implementation of the pandemic-related Medicaid extension. We find that after implementation of the coverage extension, women used twice as many postpartum services, 2 × to 10 × as many preventive, contraceptive, and mental/behavioral health services, and 37% fewer services related to short interval pregnancies within the first-year postpartum. Our findings provide timely insights for state legislators, Medicaid agencies, and members of Congress working to improve maternal health outcomes. We add empirical evidence to support broad extension of Medicaid coverage throughout the first-year postpartum.

The Impact of COVID-19 Pandemic on Outpatient Visits for All-Cause and Chronic Diseases in Korea: A Nationwide Population-Based Study

This study explores the impact of the coronavirus disease 2019 (COVID-19) pandemic on outpatient visits for all-cause and chronic diseases in 2020. We extracted the data of patients who visited medical institutions over the past five years (2016–2020) from nationwide claims data and measured the number of monthly outpatient visits. A negative binomial regression model was fitted to monthly outpatient visits from 2016 to 2019 to estimate the numbers of 2020. The number of all-cause outpatient visits in 2020 was 12% lower than expected. However, this change was relatively stable in outpatient visits for chronic diseases, which was 2% lower than expected. Deficits in all-cause outpatient visits were observed in all months except January;however, deficits in outpatient visits for chronic diseases have rebounded since April 2020. The levels of change in healthcare utilization were observed differently among disease groups, which indicates that the impacts of the pandemic were disproportionate. This study calls for a policy response to emerging and reemerging infectious diseases, as the findings confirm that a health crisis, such as the COVID-19 pandemic, could disrupt the healthcare system. Assessing the mid-to long-term impacts of COVID-19 on healthcare utilization and health consequences will require further research.

Hands-off? Laissez-faire policies on Covid-19 may exacerbate health inequalities

Purpose>This paper establishes an association between income and the likelihood of seeking medical treatment for Covid-19 symptoms in some countries. We provide an explanation for this income effect based on the stringency of government response to the pandemic and the unequal distribution of agency among social classes.Design/methodology/approach>The paper makes use of data from the Six-Country Survey on Covid-19 to establish the existence of an income effect on health utilisation, and from the Oxford Covid-19 Government response tracker to show that this income effect is associated with the stringency of governmental response to the pandemic. Data from the 2011/12 “Health and Healthcare” round of the International Social Survey Programme is used to show that this income effect cannot be explained by pre-existing patterns. An explanation for the link between government stringency and the income effect is advanced on a theoretical basis.Findings>The authors find in Britain, the US, and – with greater uncertainty – in Japan that individuals who experience potential Covid-19 symptoms are less likely to seek medical treatment if they have a lower income. The authors also show that governments in these countries adopted a less stringent response to the pandemic than the countries in our sample which do not exhibit an income effect – China, Italy and South Korea. The authors argue that laissez-faire policies place the burden of action upon the individual, activating underlying differences in agency between the social classes, and making (high) low-income individuals (more) less likely to seek medical attention.Research limitations/implications>Since there was not a direct measure of agency in the data, it could not be empirically verified that agency mediates the effect of government stringency on health utilisation. Further research could make use of datasets which incorporate such a measure, if they become available. It could also extend the geographical scope of the findings, to see if the income effect manifests in other countries which adopted a laissez-faire response to the pandemic.Practical implications>Governments should intervene more stringently during pandemics to minimise inequality in health outcomes.Originality/value>This paper establishes an association between the stringency of government response to the Covid-19 pandemic and income inequality in health utilisation. This contributes to scholarly and policy debates around health inequality in the area of social epidemiology, and the sociology of inequality more generally. It is also of relevance to the general public, in the context of a deadly pandemic.

A path to improved health workforce planning, policy & management in Canada: The critical coordinating and convening roles for the federal government to play in addressing 8% of its GDP

The goals of a health workforce system are to develop, deploy and sustain an integrated and collaborative network of health workers that is equipped with the necessary skills, supports, incentives, and resources to provide quality care that meets all population health needs in an acceptable, equitable and cost-effective manner. This requires robust data and evidence. A key problem in Canada is that it lags behind comparable OECD countries in terms of health workforce data and digital analytics. As a result, health workforce planning here is ad hoc, sporadic, and siloed by profession or jurisdiction, generating significant costs and inefficiencies for all involved. Health workers in Canada account for more than 10% of all employed Canadians and over 2/3 of all health care spending which amounted to $175 billion in 2019, or nearly 8% of Canada’s total GDP.[i]Recognizing these facts, supporting strategic health workforce planning, policy and management ought to be key priorities for federal and provincial/territorial governments and other health care organizations. Across all the different stakeholders that make up the complex adaptive health workforce system in Canada, we lack a centralized and coordinated health workforce data, analytics, and strategic planning infrastructure, a neglect that has been readily acknowledged for over a decade. The significant gaps in our knowledge about the health workforce have been exposed during the COVID-19 pandemic causing critical risks for planners to manage during a health crisis. The time is ripe for the federal government to take on a coordinating leadership role to enhance the data infrastructure that provinces, territories, regions, and training programs need to better plan for and support the health workforce. Efforts should centre on three key elements that will improve data infrastructure, bolster knowledge creation, and inform decision-making activities: * A new data standard and enhanced health workforce data collection across all stakeholders * More timely, accessible, interactive, and fit-for-purpose decision support tools * Capacity building in health workforce data analytics, digital tool design, policy analysis and management science. This vision requires an enhanced federal government role to contribute resources to coordinate the collection of accurate, standardized, and more complete health workforce data to support analysis across occupations, sectors, and jurisdictions, with links to relevant patient information, healthcare utilization and outcome data, for more strategic fit-for-purpose planning at the provincial, territorial, regional, and training program levels. In this paper, a proposed vision for enhanced federal support to data-driven and evidence informed health workforce planning, policy and management is presented. First, two data infrastructure and capacity building recommendations include: * the federal government should create through a specially earmarked contribution agreement with the Canadian Institute for Health Information a Canadian Health Workforce Initiative dedicated to the necessary enhancement of standardized health workforce data purpose built for strategic planning purposes and associated decision-making tools for targeted planning. * In addition to the need to build better data, digital tools, and decision-support infrastructure, there is a parallel need to build the human resources capacity for health workforce analytics. Through a special CIHR-administered fund to build health workforce research capacity, this could include a Strategic Training Investment in Health Workforce Research and a complementary Signature initiative to fund integrated research projects that cut across the existing Scientific Institutes. Building on these two necessary but insufficient building blocks, three options for a coordinating pan Canadian health workforce organization could include one of the following: * The federal government could create a dedicated Health Workforce Agency of Canada with an explicit mandate to enhance existing health workforce da a infrastructure and decision-support tools for strategic planning, policy, and management across Canada. * The federal government could support through a contribution agreement the creation of an arm’s length, not-for-profit organization, Canadian Partnership for Health Workforce, as a steward of a renewed health workforce strategy and to provide health labour market information, training, and management of human resources in the health sector, including support for recruitment and retention. * The federal government could support the creation of a more robust, transparent, and accessible secretariate for a Council on Health Workforce, Canada to improve data and decision-making infrastructures, bolster knowledge creation through dedicated funding and policy to inform decision-making and collaborate on topics of mutual interest. Because of the importance of the health workforce to Canada’s economy and pandemic recovery, a sizeable and sustained investment over the course of at least 10 years is needed to build the necessary infrastructure for better decision-making. In addition to building a more robust health system for Canada’s post pandemic recovery, these actions would align with the World Health Organization’s Global Strategy on Human Resources for Health (2016) which encourages all countries (including Canada) by 2030 to have institutional mechanisms in place to effectively steer and coordinate an inter-sectoral health workforce agenda and established mechanisms for HRH data sharing through national health workforce accounts. [i] In 2019, healthcare constituted 11.5% of GDP. Although the data are not readily available for the full costs of the health workforce, it is generally accepted that approximately 70% of health care costs are the costs of labour;70% of 11.5 is 8.05.

Essential public healthcare services utilization and excess non-COVID-19 mortality in Greece.

OBJECTIVES: Ensuring access to care for all patients-especially those with life-threatening and chronic conditions-during a pandemic is a challenge for all healthcare systems. During the COVID-19 pandemic, many countries faced excess mortality partly attributed to disruptions in essential healthcare services provision. This study aims to estimate the utilization of public primary care and hospital services during the COVID-19 epidemic in Greece and its potential association with excess non-COVID-19 mortality in the country. STUDY DESIGN: This is an observational study. METHODS: A retrospective analysis of national secondary utilization and mortality data from multiple official sources, covering the first nine months of the COVID-19 epidemic in Greece (February 26th to November 30th, 2020), was carried out. RESULTS: Utilization rates of all public healthcare services during the first nine months of the epidemic dropped significantly compared to the average utilization rates of the 2017-19 control period; hospital admissions, hospital surgical procedures, and primary care visits dropped by 17.3% (95% CI: 6.6%-28.0%), 23.1% (95% CI: 7.3%-38.9%), and 24.8% (95% CI: 13.3%-36.3%) respectively. This underutilization of essential public services-mainly due to supply restrictions such as suspension of outpatient care and cancelation of elective surgeries-is most probably related to the 3778 excess non-COVID-19 deaths (representing 62% of all-cause excess deaths) that have been reported during the first 9 months of the epidemic in the country. CONCLUSIONS: Greece's healthcare system, deeply wounded by the 2008-18 recession and austerity, was ill-resourced to cope with the challenges of the COVID-19 epidemic. Early and prolonged lockdowns have kept COVID-19 infections and deaths at relatively low levels. However, this "success" seems to have been accomplished at the expense of non-COVID-19 patients. It is important to acknowledge the "hidden epidemic" of unmet non-COVID-19 needs and increased non-COVID-19 deaths in the country and urgently strengthen public healthcare services to address it.