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COVID lays bare the inequalities of American health provision

The COVID-19 pandemic has led to innovations in terms of political organisation and coordination, but has also revealed weakness in the American health care system. Over the last two years, the system has focused on COVID-19 patients and on the prevention of transmission. But for those patients suffering from chronic illnesses, there have been fewer tests, routine face-to-face consultations, prescriptions and hospitalisations, with the result that mortality from non-COVID-19 diseases (cardiovascular disease, dementia, diabetes, hypertension…) has increased.

The current system does not benefit the health of patients with chronic illnesses since effective care necessitates close monitoring, and sometimes long-term changes in life-style. Health care is poorly reimbursed, while technology (paramedical equipment, etc.) and medicines fall below standards required by patients. For example, the FDA (Food and Drug Administration) has recently approved Aducanumab for the treatment of Alzheimer’s, despite the negative conclusions of the advisory committee (proof of insufficient efficacy and serious side effects).

The system is beset by inequalities and by systemic racism that affects certain sectors of the population. In addition, there are high levels of comorbidities linked to COVID-19 in marginalised communities (disadvantaged and rural areas). As a consequence, mortality is much higher in disadvantaged areas, accentuated by the fact that hospitals are clearly less well equipped, financed and supported. For example, health care workers in wealthier hospitals were prioritised in the early phases of COVID-19 vaccination, to the detriment of those working in hospitals who needed it more.

The system is based on tradition, personal interest and the pursuit of profit. It values that which is prestigious, but neglects patient needs, equity and justice. It requires thorough reform towards a global and integrative approach, taking into account medical and social needs over the long term, rather than perpetuating the current system of fee-for-service remuneration.

Beyond political reforms, decision makers in the health sector must communicate with and establish trust with communities, in order to better understand their needs as well as teaching patients to avoid life-styles that put their health at risk. For example, patients who are not equipped for Zoom consultations should be identified, and there should be an appropriate balance between face-to-face and virtual contact. In marginalised areas, the responsibilities of auxiliary medical staff could be extended, as happened during the pandemic. It is therefore crucial to identify those social factors that impact health care so as to be able to combat inequalities effectively.  

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