COVID-19 exposes gaps in the U.S. health care system

September 2nd, 2020 / By Steve Delaronde

Before COVID-19, U.S. health care was being called out for unfair billing practices. Surprise bills, confusing and excessive hospital chargemaster rates, balance billing and overreliance on fee-for-service had become familiar topics. While the COVID-19 pandemic has increased positive attitudes towards frontline health care workers, it has also intensified feelings of mistrust towards a health care system perceived by many Americans as more concerned about profits than patients.  COVID-19 presents us with an opportunity to address these failures.

A study published in the Journal of the American Medical Association in June 2019 reported that more than one-third of hospitals in Virginia filed lawsuits against patients that did not pay their medical bills. Many were shocked to learn that hospitals, whose self-described mission is to provide care regardless of ability to pay, were actually bringing lawsuits against their most vulnerable patients. Dr. Marty Makary exposes some of the hospitals that sue vulnerable patients for unpaid medical bills in his 2019 book, The Price We Pay: What Broke American Health Care – and How to Fix It.

Since March 2020, hospitals have seen a decline in revenue, mostly due to reductions in the elective procedures that comprise nearly half of their revenue. Revenue generated from outpatient and emergency department visits has also declined. Physician practices have suffered, since most of their income is still derived from fee-for-service payments for in-person visits. Does this mean that patients can continue to expect aggressive billing tactics from health care providers needing to make up a financial shortfall caused by COVID-19? Without changes to the current system, the answer is “yes.”

Attempts to contain the COVID-19 pandemic have exposed the gaps that exist within the U.S. health care system. Federal relief packages meant to cover COVID-19 testing and treatment for uninsured persons have not shielded patients from exorbitant bills. Stay-at-home orders designed to protect the public from spreading and catching COVID-19, as well as fear of contracting the virus, have kept patients from getting the care they need to manage chronic medical and behavioral health conditions.

We have an opportunity to restructure an antiquated fee-for-service payment system for primary care, eliminate surprise bills for emergency department visits and surgical procedures, and create a more equitable pricing structure that aligns with Medicare. Shortcomings of the U.S. health care system have become more pronounced since the arrival of COVID-19. The pandemic has shone a spotlight on those gaps and has reminded us that they cannot be ignored.

Steve Delaronde is manager of products for Population and Payment Solutions at 3M Health Information Systems.

Watch our COVID-19 payer webinar series on demand.


During a pandemic, information is gathered, studied, and published rapidly without the usual processes of review. Our understanding is rapidly evolving and what we understand today will change over time. Definitive studies will be published long after the fact. We share our thoughts and expertise based on currently available information.