Overcoming the Challenges of the COVID-19 Pandemic
January 15, 2021
Preparedness for COVID-19 Vaccination Programmes
January 24, 2021
How has the pandemic affected healthcare provision and financing?
The COVID-19 pandemic has caused increased stress in healthcare systems around the world. The impact has varied between countries depending on the extent of COVID-19 and the type of healthcare system.
An effective response to a pandemic requires accessible testing, tracing, treatment, and isolation facilities. The associated costs of a public health emergency must be covered by payers, whether they be governments, insurers or individuals. It is likely that health insurance premiums or taxation will be increased in the future to cover these costs.
The pandemic has highlighted health inequalities, and this is especially the case with those uninsured in countries without universal healthcare coverage.
In the USA, approximately 8.5% of the population were uninsured in 2018. Redundancies during the pandemic may have compounded this. A Commonwealth Fund survey found that 41% of respondents in the USA who reported that they are their partner had lost a job from February to May 2020 relied on that job for health insurance.
Countries have varied in their response, with many insurance-based systems waiving fees or deductibles for testing or treatment for COVID-19.
Cover for Covid-19 Testing and Treatment
Europe |
| Healthcare System |
| Coverage for Testing and Treatment |
Germany | Universal multi-payer health care system. Mandatory insurance through statutory health insurance or private insurance. | COVID-19 testing for suspected cases or contacts covered by statutory health insurance since 28 February 2020. Treatment for COVID-19 covered with adjustment to fees paid to hospitals to cover costs. | ||
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France | Universal healthcare financed by government National Health Insurance and supplemental private insurance. | Testing for COVID-19 fully covered, medical consultation and contact-tracing fully reimbursed, majority of treatment costs for COVID-19 covered through National Health Insurance. | ||
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United Kingdom | National Health Service (NHS) funded through taxation. Small private healthcare sector. | Testing for suspected cases and contacts and treatment for COVID-19 provided through NHS, including temporarily for visitors to the country during the pandemic. | ||
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Switzerland | Compulsory basic health insurance and optional supplementary cover. Public and private healthcare provision. | Federal government to cover costs of COVID-19 testing for eligible suspected cases or contacts, following public health testing and reporting criteria. Treatment for COVID-19 covered until June 2020, now depends on ‘particular situation’ under Epidemics Act. | ||
Ireland | National Public Health System funded through taxation with approximately 50% of population opting for private health insurance. | Testing and treatment for COVID-19 fully covered through Public Health System. | ||
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Middle East | ||||
United Arab Emirates | Government-funded public health system plus compulsory private insurance (mostly employer-based) for expats. | Suspected or confirmed COVID-19 cases must be treated as emergencies and therefore covered by insurer, or healthcare provider for those uninsured (DHA Circular 30 Jan 2020). | ||
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Kingdom of Saudi Arabia | National Healthcare system plus compulsory private insurance (mostly employer-based) for expats. | Treatment for suspected or confirmed COVID-19 cases to be covered by insurers (government or private). | ||
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Asia | ||||
China | Government funded social health insurance (70%) and employee-based health insurance. | Medical expenses for COVID-19 patients fully covered by social health insurance and public finance since January 2020, for Public Health Emergency. | ||
India | Approximately 37% of population covered under various public and private schemes. High out-of-pocket health expenditure. Quality and availability of free care at public medical facilities varies between states. | Free COVID-19 testing in government facilities and testing-drives but availability varies greatly. Varying responses between states. Lack of facilities in some government hospitals. Attempts to cap fees or subsidise beds for patients in private facilities with limited success. | ||
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Americas | ||||
United States of America | Combination of numerous private and non-profit insurance companies with around two-thirds of population covered by federal and state programs such as Medicare/Medicaid. | No co-pay/deductible and prior authorisation waived for testing for COVID-19 and Emergency Department Services for Medicare and Medicaid recipients with many private insurers following (since March 2020, may be extended until end of the year). Partial coverage for COVID-19 treatment for Medicare recipients, subject to deductibles. | ||
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Canada | Universal Healthcare – Medicare -funded through taxation. | Testing for suspected cases and contacts and treatment for COVID-19 provided by Medicare, with some provinces waiving the 3-month eligibility wait for new immigrants. Virtual assessment and triage for COVID-19. |
Note: This is not an exhaustive list and cover is constantly under review and subject to change.
Travel Insurance
Most Travel Health Insurers offer varying levels of cover for COVID-19 emergency medical treatment during the pandemic. Travellers should check the wording of their policies.
Several airlines are currently offering free COVID-19 insurance during the pandemic.
Increased opportunities for remote healthcare provision
The value of telemedicine and other remote healthcare services to reduce face-to-face contacts and viral transmission has been recognised during the COVID-19 pandemic.
Telehealth technology is well established, but uptake and expansion has been limited by lack of funding, or restrictions in insurance coverage.
Germany was the first country to pass comprehensive legislation for digital healthcare provision in 2019. In contrast, prior to the current pandemic, the United States had few mechanisms for reimbursement for teleconsultations, usually at a lower rate, with inconsistencies between states.
In many countries, regulations have been relaxed and reimbursement increased due to the public health emergency, leading to a marked increase use of telehealth during 2020.
Cover for remote healthcare delivery
Country |
| Coverage for Telehealth |
USA | CARE (Coronavirus Aid, Relief and Economic Security) Act, March 2020, removed many barriers and provided temporary parity of reimbursement for virtual consultations. Use of certain videoconferencing platforms permitted. CMS (Medicare/Medicaid) have revised fees to enable physicians to provide telehealth services and many private insurers have followed. Medicare extension of telehealth services covered during pandemic. Geographic/state licensure restrictions and co-payments waived. Amendments to PREP Act for COVID, temporary permission for cross-state healthcare via technologies. Many private insurers expanding telemedicine programs, to include mental health and other specialities, and temporarily waiving cost-sharing. | |
Germany | Digital Healthcare Act (Nov 2019) large-scale reimbursement plan for telehealth: Covered for statutory health insurance recipients (90% of pop). Register of approved applications. 12-month trial period to prove positive effect on care before reimbursement fee negotiated. In-person consultation no longer required before video consultation (except psychotherapy). Limitation on number of cases and proportion of services provided via video-link (previously 20%) temporarily lifted for COVID-19. Currently only applies to lower risk medical devices. | |
France | Temporary changes to telehealth coverage through National Health Insurance: 100% reimbursement for telehealth, with new patient consultations allowed. Complex consultations reimbursed at the same level as in-person. Full reimbursement for telemonitoring of COVID-19 patients by nurses. | |
United Kingdom | Increase in remote consultations through National Health Service. Private insurers offering new and expanded remote services. | |
Ireland | Access to remote general practitioner care and other telehealth services for the duration of the pandemic. | |
China | Government polices to integrate online services. Free online consultations for COVID-19 and chronic diseases. | |
India | During pandemic, Insurance Regulatory and Development Authority of India (IRDAI) has asked insurers to cover telemedicine in place of face-to-face consultations, for patients living in any part of India. Must follow the Medical Council of India guidelines. |
Note: This is not an exhaustive list and cover is constantly under review and subject to change.
Reimbursement for telehealth is one of the most important factors in uptake. Although remote care may be considered less expensive to provide than in-clinic consultations, considerable investment in the required technology and training may be required, making the argument for at least temporary reimbursement parity.
Appropriate and effective regulation is needed to ensure quality and cost-effectiveness of remote care.
There is currently no standardised framework for the regulation of transnational telemedicine.
It remains to be seen how many of the temporary provisions will be replaced by long-term policies. Although the pandemic is not over at the time of writing, several big private insurers in the USA are already starting to roll back coverage for telehealth.
Challenges and Opportunities into 2021 and beyond
– The increased use of remote healthcare delivery, if properly regulated and reimbursed, may provide long-term benefits, providing greater accessibility for remote and underserved population groups.
– The current pandemic has potentially increased the perceived value and therefore the uptake of health insurance by individuals.
– The disruption caused to healthcare providers by COVID-19 in insurance-based systems may lead to a rethink away from fee-per-service towards per-capita contracts with guaranteed payment structures.
– In the current situation, an alternative to traditional employer-based health insurance may be needed.
On a larger scale, COVID-19 has highlighted the need to work towards Universal Healthcare Coverage, to protect families against catastrophic healthcare costs and reduce inequities.
Medoment – a total engagement healthcare platform optimizes user experience and improves outcomes by integrating all aspects of the care pathway, including teleconsultations.
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