Providing care for the 99.9% during the COVID-19 pandemic: How ethics, equity, epidemiology, and cost per QALY inform healthcare policy

Healthc Manage Forum. 2020 Sep;33(5):239-242. doi: 10.1177/0840470420939854. Epub 2020 Jul 8.


Managing healthcare in the Coronavirus Disease 2019 (COVID-19) era should be guided by ethics, epidemiology, equity, and economics, not emotion. Ethical healthcare policies ensure equitable access to care for patients regardless of whether they have COVID-19 or another disease. Because healthcare resources are limited, a cost per Quality Life Year (QALY) approach to COVID-19 policy should also be considered. Policies that focus solely on mitigating COVID-19 are likely to be ethically or financially unsustainable. A cost/QALY approach could target resources to optimally improve QALYs. For example, most COVID-19 deaths occur in long-term care facilities, and this problem is likely better addressed by a focused long-term care reform than by a society-wide non-pharmacological intervention. Likewise, ramping up elective, non-COVID-19 care in low prevalence regions while expanding testing and case tracking in hot spots could reduce excess mortality from non-COVID-19 diseases and decrease adverse financial impacts while controlling the epidemic. Globally, only ∼0.1% of people have had a COVID-19 infection. Thus, ethical healthcare policy must address the needs of the 99.9%.

MeSH terms

  • Betacoronavirus
  • COVID-19
  • Coronavirus Infections / epidemiology
  • Coronavirus Infections / therapy*
  • Delivery of Health Care / economics*
  • Delivery of Health Care / ethics*
  • Health Equity / economics*
  • Health Equity / ethics*
  • Health Policy / economics*
  • Humans
  • Pandemics
  • Pneumonia, Viral / epidemiology
  • Pneumonia, Viral / therapy*
  • Quality-Adjusted Life Years*
  • SARS-CoV-2