新冠疫情、倦怠和藥物短缺：美國醫療系統運轉失靈，兒童和家長深受其害
ELLEN DASILVA
2022-12-20
疫情使兒科病房和診所的數量加速穩步減少。圖片來源：JOEL LERNER - XINHUA - GETTY IMAGES
每次走進我在曼哈頓的兒科診所，我都對人們深感同情。診所里人手不足，所有人都在連軸轉，而孩子們的醫療需求不斷增加。
過去三年，隨著疫情持續肆虐，無論是疫苗還是其他治療方法都忽視了兒童這個群體，而兒科醫生們為孩子們所做的一切堪稱奇跡。然而，在整個社會，我們對兒科健康的忽視，卻不利于家長、兒童和整個醫學體系。
作為一家兒科遠程醫療平臺的CEO，我很不幸見證了整個醫療體系以驚人的速度，不斷令家長們失望。我經常想起家長們每年要拿出大量工作時間，照顧生病的孩子。
我看到了學校停課，因為學校有32%的人感染了流感。我還想到了家長們在每次就診平均2,032美元的緊急醫療護理與養家糊口之間的艱難權衡。
醫療體系并不認為兒科醫療有利可圖，并且正在減少兒科病房和診所的數量
兒科醫院、急診科的兒科科室以及以兒科為基礎的緊急醫療診所等，都在以驚人的速度減少。這種現象早在疫情之前就已經開始。
美國兒科學會（American Academy of Pediatrics）估計，2008年至2018年期間，兒科住院病房減少了約20%。新冠疫情加快了這個趨勢，因為醫院將兒科科室改造成成人緊急護理中心，用于治療老年新冠患者。
不幸的是，這種趨勢歸根結底在于經濟學因素。醫療體系意識到，老年患者或成年患者住院所帶來的收入超過兒童患者。因此，偏遠地區的家長不得不跨州甚至駕車八個小時，為孩子獲得持續的醫療護理。這種現象的根源在于，兒童從醫療補助（Medicaid）和兒童醫療保險計劃（CHIP）獲得的賠付率更低，這兩個系統覆蓋了美國超過40%的兒童。此外，成年人的檢測和治療過程費用更高。
新冠疫情和減員加劇了醫療體系的緊張
過去三年，醫療體系承受了巨大壓力，造成醫院病房和醫療服務提供商短缺。面對可能發生的經濟衰退，經濟上的種種困境導致在疫情期間經歷過緊張狀況的許多醫院和醫療護理提供商，在財務上很難恢復元氣。
除了兒科治療資源減少以外，兒童還尤其容易受到常見病癥的影響，特別是呼吸道合胞病毒和流感，因為他們在過去兩個冬季并沒有被暴露于這些疾病。今年，兒童感染率上升了超過30%，而對乙酰氨基酚、布洛芬、阿莫西林和奧司他韋等治療呼吸道疾病的主要藥物都缺少兒科用藥。醫院病床短缺和醫生的職業倦怠，導致醫療體系無法滿足家長們為孩子們尋求治療的需求。
約20%的美國人在疫情期間推遲了接受某些醫療護理的時間。結果，隨著病情惡化，人們決定繼續接受他們一直以來忽視的治療，使醫療體系依舊承受著過重的壓力。
迫在眉睫的心理健康危機影響兒童和看護人員
發生在青少年當中的心理健康危機并不新鮮。2010年至2020年十年間，青少年自殺率穩步升高。然而，疫情嚴重加劇了這個趨勢。無法與朋友見面、日益加劇的不平等、缺少兒童看護和對健康的恐慌，給兒童和家長帶來了不可逆轉的影響。
5至11歲的兒童因為兒科心理健康問題前往急診科的比例提高了24%，12至17歲兒童的比例提高了31%，這也增加了急診醫療服務體系的工作量。
醫生加入大辭職浪潮
醫生開始感受到在一線持續奮戰三年的影響。毫不意外，有五分之一醫生表示計劃在2023年底前辭職。兒科醫生尤其存在嚴重的倦怠現象：超過61%的兒科醫生表示過去三年在工作中的持續恐慌狀態，令他們感覺不堪重負。
兒科醫療的困境不可避免。兒科醫生的供應不足與患兒的父母對兒科醫療的需求之間的不匹配，將令醫療體系難以承受。別無選擇的家長們不得不選擇更昂貴的醫療方案，包括接受緊急護理或前往急診室。
我依舊保持樂觀。新的解決方案和技術既能提供獲得醫療護理的方便途徑，又能為兒科醫生提供一種更可持續的工作環境。我們可以專注于創新，提供下一代醫療健康服務，同時讓家長們保持清醒的頭腦。（財富中文網）
本文作者艾倫·達斯維拉是Summer Health的創始人兼CEO，該公司提供基于信息的兒科醫療服務，她還參與出版了《游說與交易：關于業務開發、合作和達成重要交易的指南》（Pitching & Closing: Everything You Need To Know About Business Development, Partnerships, and Making Deals that Matter）一書。
Fortune.com上發表的評論文章中表達的觀點，僅代表作者本人的觀點，并不代表《財富》雜志的觀點和立場。
譯者：劉進龍
審校：汪皓
每次走進我在曼哈頓的兒科診所，我都對人們深感同情。診所里人手不足，所有人都在連軸轉，而孩子們的醫療需求不斷增加。
過去三年，隨著疫情持續肆虐，無論是疫苗還是其他治療方法都忽視了兒童這個群體，而兒科醫生們為孩子們所做的一切堪稱奇跡。然而，在整個社會，我們對兒科健康的忽視，卻不利于家長、兒童和整個醫學體系。
作為一家兒科遠程醫療平臺的CEO，我很不幸見證了整個醫療體系以驚人的速度，不斷令家長們失望。我經常想起家長們每年要拿出大量工作時間，照顧生病的孩子。
我看到了學校停課，因為學校有32%的人感染了流感。我還想到了家長們在每次就診平均2,032美元的緊急醫療護理與養家糊口之間的艱難權衡。
醫療體系并不認為兒科醫療有利可圖，并且正在減少兒科病房和診所的數量
兒科醫院、急診科的兒科科室以及以兒科為基礎的緊急醫療診所等，都在以驚人的速度減少。這種現象早在疫情之前就已經開始。
美國兒科學會（American Academy of Pediatrics）估計，2008年至2018年期間，兒科住院病房減少了約20%。新冠疫情加快了這個趨勢，因為醫院將兒科科室改造成成人緊急護理中心，用于治療老年新冠患者。
不幸的是，這種趨勢歸根結底在于經濟學因素。醫療體系意識到，老年患者或成年患者住院所帶來的收入超過兒童患者。因此，偏遠地區的家長不得不跨州甚至駕車八個小時，為孩子獲得持續的醫療護理。這種現象的根源在于，兒童從醫療補助（Medicaid）和兒童醫療保險計劃（CHIP）獲得的賠付率更低，這兩個系統覆蓋了美國超過40%的兒童。此外，成年人的檢測和治療過程費用更高。
新冠疫情和減員加劇了醫療體系的緊張
過去三年，醫療體系承受了巨大壓力，造成醫院病房和醫療服務提供商短缺。面對可能發生的經濟衰退，經濟上的種種困境導致在疫情期間經歷過緊張狀況的許多醫院和醫療護理提供商，在財務上很難恢復元氣。
除了兒科治療資源減少以外，兒童還尤其容易受到常見病癥的影響，特別是呼吸道合胞病毒和流感，因為他們在過去兩個冬季并沒有被暴露于這些疾病。今年，兒童感染率上升了超過30%，而對乙酰氨基酚、布洛芬、阿莫西林和奧司他韋等治療呼吸道疾病的主要藥物都缺少兒科用藥。醫院病床短缺和醫生的職業倦怠，導致醫療體系無法滿足家長們為孩子們尋求治療的需求。
約20%的美國人在疫情期間推遲了接受某些醫療護理的時間。結果，隨著病情惡化，人們決定繼續接受他們一直以來忽視的治療，使醫療體系依舊承受著過重的壓力。
迫在眉睫的心理健康危機影響兒童和看護人員
發生在青少年當中的心理健康危機并不新鮮。2010年至2020年十年間，青少年自殺率穩步升高。然而，疫情嚴重加劇了這個趨勢。無法與朋友見面、日益加劇的不平等、缺少兒童看護和對健康的恐慌，給兒童和家長帶來了不可逆轉的影響。
5至11歲的兒童因為兒科心理健康問題前往急診科的比例提高了24%，12至17歲兒童的比例提高了31%，這也增加了急診醫療服務體系的工作量。
醫生加入大辭職浪潮
醫生開始感受到在一線持續奮戰三年的影響。毫不意外，有五分之一醫生表示計劃在2023年底前辭職。兒科醫生尤其存在嚴重的倦怠現象：超過61%的兒科醫生表示過去三年在工作中的持續恐慌狀態，令他們感覺不堪重負。
兒科醫療的困境不可避免。兒科醫生的供應不足與患兒的父母對兒科醫療的需求之間的不匹配，將令醫療體系難以承受。別無選擇的家長們不得不選擇更昂貴的醫療方案，包括接受緊急護理或前往急診室。
我依舊保持樂觀。新的解決方案和技術既能提供獲得醫療護理的方便途徑，又能為兒科醫生提供一種更可持續的工作環境。我們可以專注于創新，提供下一代醫療健康服務，同時讓家長們保持清醒的頭腦。（財富中文網）
本文作者艾倫·達斯維拉是Summer Health的創始人兼CEO，該公司提供基于信息的兒科醫療服務，她還參與出版了《游說與交易：關于業務開發、合作和達成重要交易的指南》（Pitching & Closing: Everything You Need To Know About Business Development, Partnerships, and Making Deals that Matter）一書。
Fortune.com上發表的評論文章中表達的觀點，僅代表作者本人的觀點，并不代表《財富》雜志的觀點和立場。
譯者：劉進龍
審校：汪皓
I have deep sympathy every time I walk into my children’s pediatric practice in Manhattan. The place seems short-staffed, everyone is working around the clock, and the needs of our kids continue to mount.
What pediatricians have done for our children over the last three years, as the pandemic raged on and kids continued to be overlooked for vaccines and other remedies, is nothing short of a miracle. However, as a society, we’re ignoring pediatric health to the detriment of parents, kids, and medicine as a whole.
In my role as the CEO of a pediatric telehealth platform, I’ve had the unfortunate reality of witnessing the system continue to fail our parents at an alarming rate. I’m constantly reminded of the countless hours parents spend away from work every year to take care of a sick child.
I see school closures taking place because?32% of the school population has the flu. And I think about the impossible tradeoff parents have to make between getting urgent medical care for an average of?$2,032 per visit, or feeding their families.
Health systems do not find pediatric care lucrative and are downsizing pediatric units and practices
Pediatric hospitals, children’s floors in emergency departments, and peds-based urgent medicine practices are shrinking at an alarming rate. This is a phenomenon that began well before the pandemic.
The American Academy of Pediatrics estimates that between 2008-2018, pediatric?inpatient units shrank by almost 20%. The pandemic exacerbated this trend, as hospitals converted children’s floors into adult urgent care centers to treat older patients for COVID.
The unfortunate reality is that it comes down to economics. Health systems realize that they can generate more income on a bed filled with an elderly patient or an adult rather than with a child. As a result, parents in rural areas are?forced to drive across state lines or for up to?eight hours to get consistent medical care for their children. This phenomenon stems from the fact that reimbursement rates are lower for children from Medicaid and CHIP, which cover over 40% of children in the U.S. Additionally, adults are subject to more expensive tests and procedures.
COVID and cutbacks caused immense strain on the medical system
The last three years have put tremendous strain on the healthcare system, resulting in a shortage of hospital beds and providers. As we stare into a likely downturn, economic headwinds have made it difficult for many hospitals and healthcare providers to financially recover from the strain they experienced during the pandemic.
In conjunction with downsizing pediatric availability, kids are disproportionately suffering from common conditions, notably RSV and the flu, because they were not exposed to them over the last two winters. Infections were up over 30% this year–and we are facing shortages of pediatric formulations of key medicines such as acetaminophen, ibuprofen, amoxicillin, and Tamiflu to treat respiratory illnesses. Due to hospital bed shortages and physician fatigue, the system is unable to meet the demand from parents seeking care for their children.
Almost 20% of Americans delayed some form of medical care during the pandemic. As a result, the system remains overburdened as these conditions worsened and people decided that they need to catch up on the healthcare they had overlooked.
A brewing mental health crisis is affecting children and carers
The mental health crisis amongst teens isn’t news. Suicide rates among teens?climbed steadily over the decade between 2010-2020. However, the pandemic deeply exacerbated this trend. An inability to see friends, rising inequality, lack of childcare, and health scares put irreversible strain on both children and parents.
Visits to emergency departments for pediatric mental health concerns?increased by 24% for children aged five to 11 and?31% for children aged 12-17, causing a backlog in our emergency medicine system as well.
Physicians have joined the Great Resignation
Physicians are starting to feel the effects of three years of nonstop frontline work. It’s no surprise that one in five physicians say they plan to resign by the end of 2023. Pediatricians particularly suffer from tremendous burnout: over 61% cite feeling burnt out by a constant state of panic in their role over the last three years.
The crunch for pediatric care is inevitable. The system can’t sustain the mismatch of pediatrician supply and demand from parents for their sick kids. With fewer options, parents are forced to turn to more expensive options for care, including going to urgent care or the emergency room.
I remain optimistic. New solutions and technologies can both offer instant access to medical care and provide a more sustainable working environment for pediatricians. By focusing on innovation, we can provide for the health and wellness of the next generation while maintaining the sanity of their parents.
Ellen DaSilva is the founder and CEO of Summer Health, which offers message-based pediatric medical service, and the co-author of Pitching & Closing: Everything You Need To Know About Business Development, Partnerships, and Making Deals that Matter.
The opinions expressed in Fortune.com commentary pieces are solely the views of their authors and do not necessarily reflect the opinions and beliefs of Fortune.
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