Cost of contact: redesigning healthcare in the age of COVID.

During the last decade healthcare leaders, along with campaigns such as Choosing Wisely, have called for major efforts to curb the high cost of healthcare by reducing unnecessary care and eliminating waste.1 2 While these efforts have enjoyed substantial success in terms of raising awareness of unnecessary care among selected physician groups, there has been limited uptake among the majority of patients and providers. Members of the public have continued to worry more about underuse than overuse.3 Healthcare providers continue to deliver low-value care because of the lack of sufficient incentive to behave otherwise.4–6 The COVID-19 pandemic may lead to fundamental behaviour change. Now patients and healthcare providers will need to do a new kind of calculus of weighing the benefits of care against the ‘cost of contact’. For patients and providers, the risk of acquiring COVID-19 from any physical interaction with the healthcare system now constitutes a palpable cost of contact. Acutely aware of the potential risks of physical contact with the health system, many patients are deferring medical care they do not regard as essential,7 8 out of fear of contracting COVID-19. One recent analysis in the USA indicates that, while 30% of ambulatory care visits now occur virtually, the combined volume of in-person and virtual visits has decreased by 40% from prepandemic levels.9 10 Sitting in a crowded waiting room for a routine medical appointment or screening test no longer seems worth the risk. Providers also view the cost of contact with fresh eyes and a more palpable sense of risk, including the risks associated with contracting COVID and consequent transmission to other personnel, as well as consuming scarce materials, like personal protective equipment (PPE). Patients and providers will share the goal of limiting interactions with the healthcare system to medically necessary …