Nearly a million and a half people have lost their jobs in the healthcare sector in the United States since March, including 135,000 in hospitals, the latter's revenues having been reduced by the drop in the number of non-Covid patients -19.
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Since March, non-emergency operations and examinations have been canceled in most hospitals across the country. Containment has reduced the number of accidents, and many patients with chronic illnesses 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-19 patients. But in other regions less affected by the pandemic, hospitals ended up with empty beds.
In Miami, the emergency rooms of the children's hospital receive only a hundred people per 24 hours, instead of double before. 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 on 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.
" The Covid has made my work obsolete, " says a 34-year-old nurse who prefers to remain anonymous and was responsible for pre- and post-operative care. " We haven't had elective surgeries in 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, up from 36 hours previously.
Covid not profitable
" The American healthcare system is funded, and enriches many people, by providing very expensive non-emergency exams and operations, and by building giant hospitals based on this economic model, " Professor Howard told AFP. Markel, director of the Center for the History of Medicine at the University of Michigan, who herself announced that she would not be paying her employees' retirement contributions for the coming year due to the drop in revenues 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 for the March-June period. She predicts that reimbursements for Covid patients, and the $ 100 billion congressional envelope, will be insufficient to cover their actual costs, which can exceed $ 80,000 per patient if resuscitated 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 one 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. He made up for it with a little telemedicine, and has now reopened with a new source of income: testing for Covid-19.