UEHP read with enthusiasm the recent announcement by the European Commission concerning Health in Europe. We transcribe here part of the statement: “The EU4Health Programme will set out key action areas such as improvement of national health systems, measures against communicable and non-communicable diseases, availability and affordability of medicines and other crisis relevant products. Europe needs to give a higher priority to health. The new Programme will be essential in making sure that the EU remains the healthiest region in the world.”

This challenge is our challenge also. UEHP is available to participate in any action centered on innovative and efficient solutions. In the next months, we will present to the Commission relevant information supporting this common ambition, to safeguard and improve the health of European citizens. The recent crisis and the engagement of private hospitals to respond to emergency situations, demonstrate the benefits and the importance of partnership between all providers. We have to prepare the future all together!

The Spanish Private Health Alliance (ASPE), which groups more than 1,300 health entities and represents more than 80% of the Spanish private healthcare institutions, has been asking the Spanish Government for financial aid and compensation for three months to alleviate the economic deterioration caused for the service activity carried out during the public health pandemic, and the consequent impact on the sector as an essential activity without measures of labor reorganization.

The private sector is extremely concerned about the risk, already announced weeks ago, of healthcare and financial bankruptcy and denounces the disengagement by the current government from a sector that employs 266,000 people and represents 3.4% of GDP. This risk has been exacerbated during the recently completed state of alarm and leads today to the suspension of payments, competitions and closings of hundreds of health centers, mainly small clinics, unable to bear current expenses. It is currently estimated that about 2,400 health centers without hospitalization will be forced to close.

Staffed and vacant health centers

The Government, fundamentally through the Ministry of Health, has committed during this time to a response that do not meet ASPE's request for fiscal and financial measures for companies that have been through in many cases extreme situations: open as an essential activity, without patients due to confinement, with an abysmal fall in income and without solutions for labor reorganization. Today, these centers welcome about a third of the consultations they were usually completing before the state of alarm, due to the fear of contagion, the security measures and the new patient flow management.

It is necessary to convey a sense of trust to the population, for patients to know that they can go again to their doctors, specialists and usual health centers. It is safe since numerous, precautionary and preventive measures were taken against the coronavirus.

No response from the Health Department

At the beginning of June, in a meeting with the president of ASPE, Carlos Rus, Minister Salvador Illa committed to a 10-day response to specific measures to provide financial solutions and fiscal measures: compensation for patient care derived from the public care and compensation for making health care resources available under the sole command of the health authorities and the health departments of the regional governments; and a super-reduced VAT on purchases of health equipment and supplies, with effect from the activation of the state of emergency.

At the same meeting, the sector asked to be prioritized in the distribution criteria that would be set by the Royal Decree of the autonomous health fund of 9 billion euros. The Royal Decree Law 22/2020 published on 16 June and regulating the creation of the COVID-19 Fund, stated that only the regional governments could provide a financial aid to the sector.

Except for the compensation agreement already decided with the Generalitat of Catalonia for each patient and resource used, there are currently no other agreement reached with the other regional governments where compensation has been requested. However, negotiations are progressing, with varying degrees of progress, with the governments of Madrid, Murcia, the Canary Islands, Galicia, Andalusia, the Basque Country, Castile and Leon, the Balearic Islands, La Rioja, Navarre and Valencia.

A crisis with high economic impact

The impact of COVID-19 on the private healthcare sector during the most critical months of the pandemic, March and April, is documented through a study conducted by ASPE. This study analyses the healthcare activity carried out and its impact on invoicing, employment, supply costs and investments during the mentioned period.

The study was carried out on a sample of 124 health centers, which represent 27% of private hospitals and 24% of private beds. It is sufficiently representative to draw a picture of the impact that COVID-19 has had on the private healthcare sector.

The 124 private hospitals participating in the survey accounted for 16% of diagnosed patients (19,289) and 14% of ICU admissions (1,536). As regard to the activity, all healthcare areas were significantly affected: specifically, surgical interventions decreased by 83%, diagnostic tests by 79% and the emergency department by 73%, consultations by 67%, hospital admissions by 58%, laboratory determinations by 57% and ICU admissions by 52%.

The impact on billing varies depending on the region, with Murcia, La Rioja, Cantabria and Asturias being the ones that have suffered the greatest decrease. On the contrary, Madrid, Castilla y León and Catalonia have been the communities that have been less affected. The drop in billing is lower in regions having treated a greater number of COVID-19 patients and having billed insurance company activity corresponding to previous months. The centers without hospitalization have faced a drop in revenue by 85% on average compared to the usual pre-COVID activity and the hospital centers by 60%.

Regarding the hiring of staff, despite the difficulties expressed, 89% of the centers hired new professionals during the crisis.

The hospitals participating in the study have made investments related to COVID-19 worth more than 13,5 million euros and have cancelled or delayed investments worth an estimated 36,2 million euros. 33% of the investments made correspond to the purchase of equipment, 28% to the purchase of respirators, 12% to the adaptation of spaces, and the remaining 27% to other investments.

The purchase of medical supplies related to COVID-19 has increased by 71% compared to the amount spent during 2019. The price of surgical masks has increased by 1.423% compared to December 2019.

To get an idea of ​​this acceleration, just look at the figures: 4.6 million appointments made through video consultation on Doctolib since early March (compared to 100 000 before the epidemic). This massive increase speaks for the usefulness of this tool, for practitioners as well as for patients, not only during confinement but also in the time after. Indeed, since the end of confinement, Doctolib has registered 30 times more video consultations than before the epidemic.

But Doctolib's contribution did not stop at teleconsultation. We have also launched support plans for private practices to help them continue seeing their patients in their office, thanks to a new management of their calendars with areas dedicated to patients suspected or affected by Covid-19. This new management was especially designed to strengthen communication between patients and practitioners, a communication which is essential in normal times and even more vital in a crisis of such magnitude.

The crisis has highlighted the fragility and vulnerability of our health professionals at the heart of our healthcare system and has shown, to the French people, their major role. This crisis will quite probably, and rightly so, push us to consider the healthcare system as an investment and not as an expense: it is necessary to invest in people and in services, especially in the organization and the «logistics» of the healthcare system. These services already existed, and Doctolib has enabled an acceleration of this "logistics" to overcome the crisis.

In the countries where Doctolib is established (and in those targeted), what growth do you expect?

With the significant increase of digital use during the epidemic, Doctolib has risen to third place in the world for video consultation tools. I am convinced that this practice will settle long-term, as the Ministry of Health and the medical unions have been hoping for since September 2018.

Before the health crisis, we had already seen a demand from patients and doctors, this service was even developed in 70 hospitals ( for 2,000 practitioners in these structures).

However, 2 important elements:

It will not replace face-to-face consultation. It will probably represent between 15 and 20% of the activity of physicians who use it, as it is the case in the Nordic countries or certain Asian countries where this practice is already common.

It must be used for patients already followed up by doctors in accordance with their care pathway and their attending physician.

But teleconsultation is a proven practice. It allows better care of patients by improving access to care and increasing the frequency of contact with doctors, providing working comfort to health professionals while paying them well for all the work done and collaborating better with the nurses.

Regarding our growth, we continue to sign up nearly 4 000 new users each month in France.

And we are preparing new services with remarkably high added value for healthcare professionals and patients and we therefore plan to diversify our offer and increase the number of our customers.

According to Doctolib, what should post-Covid medical world look like?

This crisis has brought to the fore what we have always said: the need to bring health financing closer to innovation in health. Innovative technologies are the key to modernizing the system and making it more efficient. We hope that this can change now that Covid-19 has shown us this need, at the national level in France but also at the European level.

At Doctolib we do not believe in a digital medicine where patients consult a different doctor each time: this practice, recurrent because it is necessary during the crisis, must rightfully give way to the structured care pathway and to the relationship of trust between patient and practitioner. The role of the attending physician, who can now be consulted by video consultation as well as face-to-face, is essential and we are convinced that he must be included in a structured and regionalized care pathway. It is within this framework that we position ourselves with two main objectives: 1 / create the hospital and the office of the future where the digital leaves more room for the human, by reducing the administrative time and therefore by freeing up available medical time, and 2 / improve the care pathway and patient experience.

This is what we were already doing before Covid-19, and this is what we will continue doing after.

The research is being focused on Suceava county, as the largest outbreak of infection for the new coronavirus in Romania. The main objective of the study is to measure the immunization rate of the new coronavirus and the risk of infection, as a result of the relaxation measures.

Main conclusions

• 20% of Suceava's 25+ population was naturally immunized for COVID 19;
• The natural immunization rate is 29% in the 45-54 age group, and 3 times lower among young people aged between 25 and 34 years old;
• Age is the main demographic characteristic that discriminates in what concerns the share of those who have developed specific antibodies against the new coronavirus;
• Social class is also an important discriminator in what concerns the proportion of those who have been immunized as a result of infection with the new one coronavirus; among the immunized, fewer high-income employees with education superiors, but also entrepreneurs, directors or managers;
• Approx. 3,100 inhabitants of Suceava was over 25 years old Positive PCR at the time of development study;
• of these, 1 in 10 people diagnosed with COVID’19 became infected recently, with less than 20 days before the test period;
• 20% of the target population, 16.500 people were immunized naturally following SARS CoV 2 infection.

Details

Regarding the infection rate, the study shows that out of the 512 Suceava tested, 3.7% were confirmed positive for the new coronavirus, which were communicated to DSP according to the protocols in force. Compared to the number of inhabitants over 25 years old in Suceava, this percentage indicates that at this moment over 3000 inhabitants in Suceava are carriers of the virus. At the same time, the study data show that all test subjects whose RT-PCR test was positive did not show any symptoms at the time of testing. According to MedLife representatives, the result is interesting because it shows a much different clinical picture than the one described in the studies published in the first month of the pandemic.

According to internationally published data, asymptomatic patients screened with IgV anti-SARS CoV 2 positive and RT PCR positive in nasal and pharyngeal exudate most likely no longer have an infectious risk for contact. The dynamics of RT PCR and IgG antibodies show a significant decrease in viral load after the first 7 days after the onset of the disease, and IgG antibodies appear after day 14, which is associated with decreased risk of contagion. According to data published by South Korean authors, a positive PCR RT test after declaring a cure through two negative tests is more like residual genetic material in nasopharyngeal epithelial cells and less replicative virus.

The MedLife study took place between 18 and 28 May 2020, on a sample of 512 people, among the population of Suceava over 25 years old. The research was performed to determine the degree of natural immunization of the population for COVID 19 with the development of IgG antibodies and the level of infected with the new coronavirus.

Two test methods were used for this study: the molecular method RT-PCR considered gold standard for the detection of Sars CoV 2 virus and the serological test by the Chemiluminescence method for the determination of IgG antibodies.

Having an overview as a result of the study, Medlife believes that the situation in Suceava is relevant and that isolation measures have been welcome. If we refer to the results of our first study, conducted nationwide and which indicates that less than 2% of Romanians had antibodies a few weeks ago, it was natural to resort to isolating the outbreaks. Moreover, both the results of the first study and the results of the second show us that the Romanian population is more resistant to the virus than initially estimated, but this does not mean that we must give up protection measures and those of social distancing. We believe that all indications from the Ministry of Health must be followed carefully because there are still a significant number of asymptomatic patients who can spread the disease. It is necessary to protect especially the elderly and those who have medical conditions that, associated with Sars CoV 2 infection, can have very serious consequences.

As explained by Rodolphe Eurin, director of the La Tour Hospital, the activity first came to an abrupt halt on March 13 following a decision by the Federal Council, then the hospital reorganized itself to accommodate all the patients referred by the HUG. In the end, many patients without supplementary insurance were admitted - about six times more than in normal times - considerably modifying the hospital's income structure. The shortfall for March and April has exceeded 75%, so the hospital is currently negotiating with the canton to compensate for the costs of requisitioning its facilities. On the other hand, staff on short-time working continued to receive 100% of their salary, whereas insurance normally covers only 80%.

Since 27 April, activity has gradually resumed, but has not yet reached the pre-Covid level. Some patients, for fear of contamination, are postponing their consultations or elective procedures.

The crisis is also an opportunity

Telemedicine consultations have been well received by patients and practitioners have adapted their practices to the situation to avoid disruptions in care. Emergency telemedicine was implemented using a digital sorting application, facilitating online emergency consultations, reducing not only the waiting time and the risk of contagion, but also consultation costs. In the future, outpatient surgery care will be preferred compared to hospitalization.

In addition, this extraordinary situation has made it possible to highlight the care professions, the employees and their commitment, as well as the rich and supportive social fabric of an entire region. Wishing to thank its employees for their commitment during the pandemic, the La Tour Hospital decided to support the economic fabric of Meyrin by offering its employees 1,500 meal vouchers in 10 restaurants near the hospital. A doubly winning and supportive initiative.

And throughout the Covid crisis, the La Tour Hospital posted a series of testimonials on social networks in the form of video clips, of the hospital's healthcare workers, on the front line facing the pandemic. An original idea to decompartmentalize in time of confinement and bring out the invaluable work of the teams.

A sustainable medicine

And in recent days, the La Tour Hospital has been the first private healthcare establishment in French-speaking Switzerland to adopt a "smarter medicine", a campaign which aims to promote rational and reasoned medical decisions, by eliminating certain unnecessary medical examinations and prescriptions, for a better quality of care delivered.

Seven common routine measures are currently evaluated. The aim is to avoid unnecessary prescription of three drugs: antibiotics, benzodiazepines for immobilization and proton pump inhibitors for stomach problems, and to study the relevance of certain radiological and biological examinations and blood transfusions and permanent catheters.

"It would be very short-sighted not to tackle quality improvement for the benefit of the patient. Our long-term goal is for patients to trust their hospital for the care they receive there, "concludes Rodolphe Eurin.

A major step towards a smarter and more sustainable medicine.