Almost one and a half million people have lost their jobs in the healthcare sector in the United States since March, including 135 000 in hospitals, their revenues having been reduced by the drop in the number of non-COVID patients – 17.
Since March, non-emergency operations and examinations have been canceled in most hospitals in the country. Containment has reduced the number of accidents, and many chronically ill patients avoid hospitals for fear of being infected with the new coronavirus.
In New York, caregivers of all specialties, even from the rest of the country, lent a helping hand to manage the tsunami of COVID patients – 17. But in other areas less affected by the pandemic, hospitals ended up with empty beds.
In Miami, the children's hospital emergencies only receive a hundred people per 24 hours, instead of double . Vacancies for self-employed nurses were cut in early April, as were those for Dayna James, 40, who worked in the emergency room two days a week.
“In South Florida, there are not enough patients, the hospital cannot afford to pay all the staff who have nothing to do,” said the nurse to AFP. “It's sad, it was my vocation, my career for 17 years”.
She remains “on call”: the hospital called her Sunday, Mother's Day here. “No one wanted to work, but I was desperate, of course I went to work.”
In Washington, in March, hip or knee operations, appendectomies, non-urgent bladder ablations or even medical imaging exams were postponed indefinitely. But there was no COVID peak requiring general staff mobilization.
“COVID has made my work obsolete,” says a nurse 34 years old who prefers to remain anonymous and took care of pre and postoperative care. “We have not had elective surgeries for two months, when it was the main source of revenue for our service.”
In the American system, many nurses are self-employed and are “per diem”, which allows the hospital to cut staff costs overnight. The Washington nurse only works nine hours a week, compared to 36 before.
COVID not profitable
“The American health system is funded – – and enriches many people – by providing very expensive non-emergency examinations and operations, and by building giant hospitals on the basis of this economic model”, said at l AFP Professor Howard Markel, director of the Center for the History of Medicine at the University of Michigan, who herself has announced that she will not be paying employee retirement contributions for the coming year, due the drop in revenue in his medical center.
Health insurance, both private and public, pays “when you put a tube in someone, not when you talk to them,” says Howard Markel to schematize a system that encourages inflation.
Since there is no single payer, a role played by the State elsewhere, prices are not capped and depend on the balance of power between hospitals and insurers.
The American Federation of Hospitals estimates the losses at 200 billion dollars for the period March-June. It provides that reimbursements for COVID patients, and the envelope of 100 billion voted by Congress, will be insufficient to cover their real costs, which may exceed 80 000 dollars per patient for resuscitation with a respirator, according to the Kaiser Family Foundation.
Beyond the hospitals, part of the medical system completely shut down during confinement. Dentists' offices have lost 500 000 jobs in a month, according to government statistics. Same catastrophe for podiatrists, ophthalmologists, physiotherapists …
Even in New York, pulmonologists have closed their offices. Doctor Len Hurovitz, who employs two workers, closed for five weeks. “The third week of March, the phone stopped ringing,” he told AFP.
It compensated with a little telemedicine, and has now reopened with a new source of income: to practice COVID screening tests – 19.