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Tracking The Pandemic’s Effects On Health Outcomes, Costs, And Access To Care

Since 2014 the Peterson Center on Healthcare and KFF (Kaiser Family Foundation) have partnered on the Peterson-KFF Health System Tracker to provide up-to-date information on health system performance. The Center and KFF started the Tracker to fill the need for information on how well the US health system performs across a variety of metrics, over time and in comparison to other countries.

The Center is a nonprofit organization dedicated to making higher-quality, more affordable health services a reality for all Americans. Established by the Peter G. Peterson Foundation, the Center collaborates with stakeholders across the health system and engages in grant making, partnerships, and research.

KFF is a public charity serving as a nonpartisan source of facts, analysis, and journalism for policy makers, the media, the health policy community, and the public. Approximately 70 percent of KFF operations are funded by an endowment and 30 percent by external sources, such as the Center.

With the Center’s work to improve the quality and affordability of the US health system and KFF’s long-established voice in national and global health policy dialogues, the two organizations are well positioned to partner on the Tracker project and establish a source for policy-relevant information to build public will for change in US health policy. The Tracker seeks to inform the public by providing timely analyses, interactive data tools, and a data dashboard, each of which presents information in narrative form and through easy-to-interpret visualizations. With the long-term ongoing partnership between the Center and KFF, the Tracker has built a dedicated and growing audience, consistently increased website visitors, and formed a “go-to” space for current and relevant information.

During the pandemic the Tracker has been a uniquely comprehensive source of information across each of the domains of US health system performance: costs, quality, access, and, most importantly, health outcomes. In 2021 the Tracker published more than 20 original analyses that highlighted the impact of the pandemic and related policy changes on the US health system, insurers, and patients.

In this article we summarize findings from these analyses with an emphasis on the pandemic’s impact and discuss what we’ll be tracking in 2022. Tracker analyses found that the pandemic resulted in significant disruptions to longstanding trends in health outcomes, spending, and access to care:

  1. The tragic number of deaths during the pandemic has driven US life expectancy down by 1.8 years compared to before the pandemic, and this is three times the drop seen in peer nations.
  2. Health services utilization dropped in 2020 due to delayed and forgone care and has yet to fully rebound.
  3. In 2020, out-of-pocket and private insurance spending declined for the first time in recorded history, but overall health spending in the US grew in 2020, driven up by federal relief.
  4. The rapid rise in telemedicine use helped access to care during the pandemic, but still one in four adults reported delaying or forgoing care due to the pandemic.

Contents

Health Outcomes

By summer 2021, adults in the US generally could have been fully vaccinated and protected from most cases of severe illness or death due to COVID-19. Still, a Tracker analysis showed that COVID-19 ranked among the top-three leading causes of deaths for age groups over 25 years in August, September, and October 2021.

The US already had a lower life expectancy than peer countries did, and COVID-19 is worsening the gap between the US and its peers. COVID-19 has consistently ranked as a leading cause of death in the US—in some months contributing to more deaths than cancer or heart disease did. While similarly large and wealthy Organization for Economic Cooperation and Development (OECD) nations saw an average drop in life expectancy of 0.5 years, this was less than a third of the drop seen in the US (1.8 years). Black and Hispanic people in the US experienced a disproportionately large decrease in life expectancy of about three years, compared to the 1.2-year drop experienced by non-Hispanic White people in 2020.

Health Spending

The vast majority of COVID-19 hospitalizations and deaths have been among unvaccinated adults. Tracker analyses have found that 163,000 COVID-19 deaths and nearly 700,000 COVID-19 hospitalizations among unvaccinated adults in the US from June-November 2021 would have been prevented with vaccinations. The societal cost of COVID-19 hospitalizations—the majority of which are now preventable—is in the billions of dollars. Just from June through November 2021, the cost of vaccine-preventable hospitalizations reached $13.8 billion.

There was a historic decrease in health service utilization caused by the pandemic in early 2020 in early 2020. However, annual national health expenditures ultimately increased by 9.7 percent in 2020. This increase was driven in large part by federal spending in response to the pandemic. Despite the overall rise, private insurance and out-of-pocket spending on health dropped for the first time in recorded history in 2020. The Tracker’s National Health Spending Explorer uses National Health Expenditure Account data to generate custom charts, which show that after years of relatively small increases in public health spending, these expenditures grew 113 percent in 2020.

Access And Affordability

While health services utilization was suppressed by the pandemic, the federal government, providers, and insurers introduced important changes to address access and affordability concerns. Private insurers introduced cost-sharing waivers in 2020, which can lessen the financial burden that beneficiaries face from COVID-19 treatment costs. In 2021, however, the Tracker found that insurers have largely phased out cost-sharing waivers for COVID-19 treatment. Government policies and industry efforts also promoted telehealth and helped maintain insurance coverage, yet more than one in four adults (26 percent) still reported delaying or forgoing needed medical care due to the pandemic.

Congress also passed laws ensuring that the cost of many COVID-19 tests would be covered by insurance. Despite limited compliance by hospitals for making prices publicly available, the Tracker was able to leverage price transparency requirements and data to highlight the variable and sometimes high prices that hospitals were charging for COVID-19 tests ($20–$1,419 per test). The range of COVID-19 test prices is consistent with the substantial price variation we see in other health services. For example, another Tracker analysis showed that the price of a lower spine MRI varies from $400 to $1,100 across metropolitan areas.

What We’ll Be Tracking In 2022

The Tracker has provided essential information on the performance of the health system and will continue monitoring issues affecting health sector spending, access, affordability, and quality of care throughout 2022.

A leading question will still be what the pandemic’s long-term impact is on health outcomes. In addition to the direct effect of COVID-19 on longevity and quality of life, we will be looking to see whether missed and delayed care indirectly stemming from the pandemic will result in greater disease acuity or worse health outcomes.

Access and affordability will remain a key focus, as a host of changes take shape in 2022. Health sector employment may be an ongoing challenge as providers face enduring pressures from burnout and increased patient demand. Regarding patient affordability, some pandemic-related cost relief is scheduled to expire, while protections against surprise medical bills take effect in 2022. Despite surprise billing protections applying to a wide range of circumstances, there are notable exceptions. One exception is ground ambulance rides, half of which lead to out-of-network charges and the possibility for surprise bills. The new protections are likely to decrease occurrence of some surprise billing, but the overall effect on health spending remains unclear.

2022 also includes the continued roll-out of price transparency requirements that the Tracker will monitor. To date, public awareness of the newly available price transparency data has been low—only about one in ten adults are aware that hospitals must publicly post prices online. Along with the need for greater awareness, price transparency data will also require greater standardization from hospitals and complementary information from insurers on cost sharing to be usable and meaningful for patients and other stakeholders.

Lastly, we will analyze how system changes are factoring into health services utilization, delivery, and spending. A primary question will be whether pandemic-initiated health service delivery shifts—such as telehealth—continue at the same levels and whether these affect overall spending or utilization trends.

How Philanthropies Can Address Data Needs

Philanthropic efforts—such as the Tracker—can play a key role in monitoring and analyzing data to improve public health, but challenges remain that philanthropies can help address. Many health sector data sources have significant lag, impeding our ability to understand and respond within a rapidly moving environment like we have observed during the pandemic. A long-term solution will require improvements to our data infrastructure, although the Tracker has taken advantage of surveys and newly available data. Compared to claims data, which may take years before researchers can use them, surveys can provide earlier feedback and inform action. For example, KFF has conducted regular surveys and created a Vaccine Monitor Dashboard that provides sentinel information on vaccine hesitancy.

Philanthropic involvement can help with the funding and partnership building that’s necessary to assess data accuracy, improve data infrastructure, and ultimately produce meaningful analysis. Newly available data, including those presented through new partnerships or because of recent federal requirements, have supported novel analyses on the Tracker. For example, Tracker analyses have used electronic health records data to examine the pandemic’s impact on hospital utilization and clinical outcomes.

Price transparency data may also prove useful for understanding health system costs but will first require vetting to assess usability. The Tracker has previously shown early challenges with hospital price data, and further philanthropic support could highlight the ongoing implementation of price transparency requirements, outline remaining needs to make data usable, and actually analyze how prices relate to health care cost, quality, and outcomes.

[“source=healthaffairs”]

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