Healthcare Safety Nets during COVID-19: Comparison
Please note this is a comparison between Version 2 by Bruce Ren and Version 1 by Bom-Mi Park.

 의료Medical safety net is an important concept 안전망은 COVID-19 전염병 동안 중요한 개념입니다.during covid-19 infectious diseases. In the case of COVIDcovid-19와 같은 상황에서 의료 안전망은 안전 요구 사항을 충족하고 삶의 질을 개선하며 환자 이직률과 사망률을 줄이도록 설계되었습니다, the medical safety net meets the safety requirements, improves the quality of life, and reduces the turnover rate and mortality of patients. 

  • healthcare safety net
  • safety net
  • COVID-19 pandemic
  • double diamond model
  • concept analysis
  • healthcare system
  • health inequality
  • healthcare accessibility

Note: The following contents are extract from your paper. The entry will be online only after author check and submit it.

1. Healthcare Safety Net Analysis

To control COVID-19 and prevent unnecessary suffering and economic loss, group behavior must be improved [36][1] and a clear definition of a healthcare safety net must be established [37][2]. This study used the concept analysis developed by Walker and Avant (2005) [19][3] and the double diamond model (1996) [15][4] to analyze the concept of the healthcare safety net during COVID-19. Capacity, accessibility, health equality, and education were identified as the attributes of this analysis.
Healthcare safety is a broad concept, and a net is any system that provides an opportunity to meet the needs of individuals or households facing difficulties. While the concept includes all people, low-income and poor groups are a narrow concept within it [38][5]. A healthcare safety net is very important for public safety since it is the sole provider of first-line emergency care, as well as routine healthcare through hospital EDs, EMS providers, and public/free clinics [24][6]. In particular, the ED is where the occurrence of disease burden and imbalances can be monitored, and targeted and culturally appropriate responses implemented [35][7]. Therefore, to increase the capacity of a healthcare safety net, support for physician practices, hospitals, and healthcare systems [39][8], expansion of treatment capabilities, and maintenance of the capacity of treating hospitals [40][9] must be ensured.
Given that COVID-19 is a global pandemic, healthcare services need to be highly accessible [41][10]. However, socioeconomic disparities have only worsened during the COVID-19 pandemic [32][11], with difficulties in accessing telemedicine for low-income people and those with language limitations emerging as increasingly relevant issues [42][12]. Good access to healthcare services can help expedite detection and treatment of COVID-19 patients [32,41][11][10] and reduce the mortality rate [43][13]. Accordingly, to increase the accessibility of a healthcare safety net, the accessibility of essential healthcare must be ensured [33][14], including COVID-19 testing [40][9], access to healthcare services [41][10], telemedicine services [33][14], and vaccinations [43][13].
Health equity implies the absence of unjust and preventable differences in health between groups of people [31][15]. However, a lack of personal protective equipment, limited staff to screen for COVID-19 [40][9], language barriers, insufficient data plans, and legal barriers in accessing technology or the Internet [44][16] have caused health inequalities. Moreover, health disparity is associated with an increased risk of serious diseases due to COVID-19 infection [45][17]. Therefore, people must be able to receive essential treatment [37][2] regardless of race and ethnicity [32][11], insurance coverage, or financial background to ensure that healthcare inequalities do not occur during the COVID-19 pandemic. In particular, public policy responses at government levels must call [46][18] for the expansion of essential healthcare [38][5], equitable allocation of resources [46][18], and balance [42][12].
A healthcare safety net encompasses both first-line emergency care and routine healthcare [24][6]. In particular, COVID-19 has forced healthcare professionals, healthcare systems, scientists, and policy makers to resolve social inequalities to improve the health and well-being of people [32][11]. However, to prolong this effect, treatment and public health education are needed [32][11]. Additionally, education on the rapid utilization of health information technology to coordinate healthcare and public health responses to COVID-19 is needed [40][9]. Educational programs help nurses better care for their patients, increase their confidence, and ultimately improve the quality of patient care [47][19]. Government and health systems are providing education to those affected by COVID-19 for psychological and social cohesion, as well as providing updates on the discovery and development of the latest pandemic, improving nurses’ abilities to care for patients with COVID-19 [48][20]. Additionally, nurses contribute to providing a better working environment by providing emotional support through education to employees who are concerned about being infected with the virus themselves [49][21]. Therefore, a healthcare education system that can enhance the level of knowledge about COVID-19, actively practice prevention activities [50][22], and increase patient participation must be implemented [44][16].

2. The Effect of Healthcare Safety Nets

간호 인력은 전 세계 보건 인력의 거의 50%를 차지하며 병원 및 장기 요양 시설에서 간호를 제공하며 전염병 확산에 맞서 싸우는 최전선에 있습니다[ 51 ]. 코로나19가 전 세계적으로 확산되면서 간호사들은 코로나19에 과도하게 취약하고, 코로나19에 감염된 환자를 돌보느라 육체적, 정신적으로 지쳐가고 있다[ 52 ]. 따라서 간호에서의 건강안전망에 대한 명확한 정의가 필요하다[ 52 ].
대부분의 국가는 지난 사스(SARS)와 같은 전염병 이후 공중보건 조언을 듣지 않아 코로나19로 어려움을 겪고 있다[ 53 ]. 또한 사회경제적 지위의 차이와 건강불평등은 더욱 명확해지고 적절한 의료안전망의 개념은 명확하지 않다[ 53 ]. 한국의 코로나19 사태에 큰 역할을 한 공립병원은 환자의 의료접근성을 확보했고, 공립병원은 코로나19 전담병원으로 지정돼 집중치료 중인 감염환자의 음압격리병상을 확보했다[ 54]. 발열, 두통, 호흡곤란 등의 증상이 없는 사람에게는 무료로 코로나19 선제 검사를 제공하여 무증상 환자를 사전에 발견하고 치료할 수 있도록 했다[ 54 ]. 생활치료센터에서 진료, 간호, 상담, 검진, 투약, 모니터링 등 코로나19 치료를 받을 수 있었다[ 54 ]. 공립 병원은 의료 안전망의 모든 속성을 포함하는 것으로 생각됩니다.
전염성이 강한 코로나19 바이러스로부터 의료진을 보호하고 병원 및 보건소를 방문하는 다른 환자들을 보호하기 위해 건물 외부에 임시 진료소를 마련해 검체 채취나 드라이브 스루를 실시해 외출 없이 검사를 받을 수 있도록 했다. 자동차 [ 55 ]. 한국은 질병관리본부를 중심으로 각 부처의 집중적인 노력과 의료계와 시민의 적극적인 참여를 통해 효과적인 방역사업을 추진하고 있다[ 55 ]. 질병관리본부는 코로나19에 대한 정확한 정보를 국민에게 신속하고 투명하게 전달함으로써 국민의 지지를 받고 있다[ 55 ]. 그러나 조기 교육을 강화해야 합니다 [55 ].
건강형평성 문제를 해결하기 위해서는 하류의 시급한 대응과 상류 또는 중류의 기여요인에 대한 대책이 동시에 필요하다[ 56 ]. 예를 들어, 개인 수준의 측정이 일반적으로 건강 행동이나 건강 수준과 같은 차별적인 결과를 나타내는 인구 집단에 대한 결과의 영향을 줄이기 위한 다운스트림 수준 접근이라고 하는 경우, 고용, 교육, 소득격차와 같은 사회경제적 여건과 같은 제도적 차원의 건강격차 측정은 업스트림 접근법[ 56]. 이는 본 연구에서 보건의료안전망의 선행요인으로 제시한 건강불평등의 대내외적 요인과 관련이 있는 것으로 판단된다. 본 연구에서 제시한 건강불평등 요인을 낮춤으로써 의료안전망의 실효성을 높일 수 있을 것으로 판단된다. 세계적 대유행(Pandemic) 대응 단계에서는 재난구조 및 실업급여 등 당면한 부담에 대한 긴급 대응에 중점을 두면서 준비와 회복에 있어 사회건강 결정요인과 관련된 조치를 강조해야 한다[ 57]. 예를 들어, 공중 보건 및 의료 시스템 구축, 기본적인 경제 보안, 디지털 인프라에 대한 액세스 보장, 검역 규칙 준수 시스템 구축, 안전하고 형평성 등의 분야에 더 많은 투자가 필요합니다. 사회 기반 시설 [ 57 ].
COVID-19로 인해 사회적, 경제적으로 박탈된 인구는 전염병에 취약하고[ 7 ], 과거 전염병과 최근 자연재해를 경험한 소외된 인구는 건강 불평등[ 58 ]을 보게 될 것 입니다. 따라서 COVID-19에 취약하고 건강 불평등으로 고통받는 사람들에 대한 경제적, 사회적 보호 조치를 취함으로써 SES와 미래 전염병 및 자연 재해로 인한 건강 불평등 사이의 격차를 줄이는 것이 가능할 것입니다. 특히 한국은 직장 내 코로나19 양성 사례가 많다[ 59 ]. 따라서 대기업 근로자는 재택근무가 가능하지만 중소기업 근로자는 코로나19로 인한 실업 위험에 노출돼 코로나19에 취약하다.60 ]. 이에 우리나라는 직장 내 집단감염 예방을 위해 사회적 거리두기, 유연근무제, 감염 의심근로자 조기 파악, 직장 소독 등을 통해 집단 감염 확산 방지에 노력하고 있다[ 59 ].
Walker and Avant (2005) [ 19 ] 그리고 더블 다이아몬드 모델 (1996) [ 15]은(는) 의료안전망 개념의 정확한 사용과정을 모델링하고, 단계별로 적절한 프로세스를 통해 코로나19 상황에서 재정의된 의료안전망을 제공할 수 있다. 이 프로세스를 통해 의료 안전망에 있는 사람들의 잠재적인 요구 사항을 식별하고 시각화할 수 있습니다. 본 연구에서 제시하는 의료안전망은 모든 국민에게 적용되도록 설계되었으며, 이 의료안전망을 통해 모든 국민은 코로나19 상황에서 의료서비스를 받을 수 있다. 나아가 이들의 삶의 질을 높이고 사망률을 줄이는 방향을 제시하고자 한다. 코로나19를 종식시키기 어렵다는 점을 인식하고 의료안전망을 비롯한 모든 자원을 동원해 코로나19 대응 전략을 강구해야 한다[ 60 ]. Nursing personnel account for nearly 50% of the global health workforce, providing nursing in hospitals and long-term care facilities, and they are at the forefront of the fight against the spread of the pandemic [23]. As COVID-19 spreads worldwide, nurses are disproportionately vulnerable to COVID-19 and are physically and mentally exhausted as a result of taking care of patients infected with COVID-19 [24]. Therefore, a clear definition of a health safety net in nursing is needed [24]. Most countries are struggling with COVID-19 because they have not listened to public health advice after epidemics, like the last outbreak of SARS [25]. Additionally, differences in socioeconomic status and health inequality have become clearer, while the concept of an appropriate healthcare safety net is not clear [25]. Public hospitals, which played a major role in Korea’s COVID-19 situation, ensured healthcare access for patients, and public hospitals designated as COVID-19 exclusive hospitals to secure negative pressure isolation beds for intensively treated infectious patients [26]. Anyone with no symptoms such as fever, headache, or difficulty breathing was provided with free COVID-19 preemptive tests so that asymptomatic patients could be detected and treated in advance [26]. It was possible to receive COVID-19 treatment such as treatment, nursing, counseling, examination, medication, and monitoring at the living treatment center [26]. It is thought that public hospitals include all the attributes of a healthcare safety net. To protect healthcare staff from the highly contagious COVID-19 virus and to protect other patients visiting hospitals and public health centers, a temporary clinic has been established outside the building to collect samples or drive-thru so that testing can be done without getting out of the car [27]. Through intensive efforts from all government ministries led by the Korea Centers for Disease Control and Prevention (KCDC), and active participation of the healthcare community and citizens, the Republic of Korea is carrying out an effective quarantine project [27]. The KCDC is receiving support from the public by quickly and transparently delivering accurate information about COVID-19 to the public [27]. However, early education needs to be strengthened [27]. In order to solve the health equity problems, an urgent response from the downstream and countermeasures for contributing factors from the upstream or middle are required at the same time [28]. For example, if measures at the individual level are generally referred to as downstream-level approaches to reduce the effect of the results on a population group that shows discriminatory outcomes such as health behaviors or health levels, it is likely that measures that contribute to the health gap measures at the institutional level, such as socioeconomic conditions like employment, education, and income disparity, are upstream approaches [28].This is considered to be related to the internal and external factors of health inequality suggested as antecedent factors of the healthcare safety net in this study. It is believed that the effectiveness of the healthcare safety net can be increased by lowering the factors of health inequality presented in this study. In the response stage of a global pandemic, while focusing on urgent responses to immediate burdens such as disaster aid and unemployment benefits, in preparation and recovery, measures related to social health determinants should be emphasized [29]. For example, it will be necessary to invest more in equity in areas such as the establishment of a public health and healthcare system, basic economic security, guaranteed access to digital infrastructure, establishment of a system to comply with quarantine rules, and safe and equitable social infrastructure [29]. Populations socially and economically deprived due to COVID-19 are vulnerable to epidemics [30], and marginalized populations who have experienced past epidemics and recent natural disasters will see health inequality [31]. Therefore, it will be possible to reduce the gap between SES and health inequality from future infectious diseases and natural disasters by taking economic and social protective measures for those who are vulnerable to COVID-19 and suffer from health inequality. In particular, Korea has many COVID-19-positive cases in the workplace [32]. Therefore, workers of large companies can work from home, but workers of small and medium-sized enterprises are vulnerable to COVID-19 as they are exposed to the risk of unemployment due to COVID-19 [33]. Accordingly, Korea is making efforts to prevent the spread of group infection by utilizing social distancing, flexible working hours, early identification of suspected infected workers, and disinfection of the workplace to prevent group infections occurring at the workplace [32].

References

  1. Blumenthal, D.; Fowler, E.J.; Abrams, M.; Collins, S.R. Covid-19—Implications for the Health Care System. N. Engl. J. Med. 2020, 383, 1483–1488.
  2. Chatterjee, P.; Sommers, B.D.; Joynt Maddox, K.E. Essential but Undefined—Reimagining How Policymakers Identify Safety-Net Hospitals. N. Engl. J. Med. 2020, 383, 2593–2595.
  3. Walker, L.O.; Avant, K.C. Strategies for Theory Construction in Nursing; Pearson/Prentice Hall: Upper Saddle River, NJ, USA, 2005; Volume 4.
  4. Design Council. The Design Process; What is the Double Diamond? London: Design Council. 2015. Available online: https://www.designcouncil.org.uk/news-opinion/what-framework-innovation-design-councils-evolved-double-diamond (accessed on 17 March 2015).
  5. Shin, Y.; Shin, H.; Hwang, D.; Kim, H.; Kim, J. Establishment of the Health Care Safety Net and Policy Task; Institute for Health and Social Affairs: Seoul, Korea, 2006; ISBN 978-89-8187-396-7.
  6. Taylor, T.B. Threats to the health care safety net. Acad. Emerg. Med. 2001, 8, 1080–1087.
  7. Misa, N.Y.; Perez, B.; Basham, K.; Fisher-Hobson, E.; Butler, B.; King, K.; White, D.A.E.; Anderson, E.S. Racial/ethnic disparities in COVID-19 disease burden & mortality among emergency department patients in a safety net health system. Am. J. Emerg. Med. 2020.
  8. Bryan, A.F.; Tsai, T.C. Health Insurance Profitability During the COVID-19 Pandemic. Ann. Surg. 2021, 273, e88–e90.
  9. Sadasivaiah, S.; Shaffer, E.; Enanoria, W.; Su, G.; Goldman, S.; Scarafia, J.; Lee, T.; Yu, A.; Goldman, L.E.; Ratanawongsa, N. Informatics response to address the COVID-19 pandemic in a safety net healthcare system. JAMIA Open 2021, ooaa057.
  10. Napoleon, S.C.; Maynard, M.A.; Almonte, A.; Cormier, K.; Bertrand, T.; Ard, K.L.; Chan, P.A. Considerations for STI Clinics During the COVID-19 Pandemic. Sex Transm. Dis. 2020, 47, 431–433.
  11. Lopez, L., 3rd; Hart, L.H., 3rd; Katz, M.H. Racial and Ethnic Health Disparities Related to COVID-19. JAMA 2021, 325, 719–720.
  12. Cheng, T.L.; Moon, M.; Artman, M.; On behalf of the Pediatric Policy Council. Shoring up the safety net for children in the COVID-19 pandemic. Pediatric Res. 2020, 88, 349–351.
  13. Dhanda, S.; Osborne, V.; Lynn, E.; Shakir, S. Postmarketing studies: Can they provide a safety net for COVID-19 vaccines in the UK? BMJ Evid. Based Med. 2020.
  14. Lau, J.; Knudsen, J.; Jackson, H.; Wallach, A.B.; Bouton, M.; Natsui, S.; Philippou, C.; Karim, E.; Silvestri, D.M.; Avalone, L.; et al. Staying Connected In The COVID-19 Pandemic: Telehealth At The Largest Safety-Net System In The United States. Health Aff. 2020, 39, 1437–1442.
  15. Cho, S.-I. Health equity. Korean Med Assoc. 2015, 58, 1104–1107.
  16. Peynetti Velázquez, P.; Gupta, G.; Gupte, G.; Carson, N.J.; Venter, J. Rapid implementation of telepsychiatry in a safety-net health system during COVID-19 using Lean. NEJM Catal. Innov. Care Deliv. 2020, 1. Available online: https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0319 (accessed on 17 July 2020).
  17. Long, B.; Brady, W.J.; Koyfman, A.; Gottlieb, M. Cardiovascular complications in COVID-19. Am. J. Emerg. Med. 2020, 38, 1504–1507.
  18. Bambra, C.; Riordan, R.; Ford, J.; Matthews, F. The COVID-19 pandemic and health inequalities. J. Epidemiol. Community Health 2020, 74, 964–968.
  19. Zandian, H.; Alipouri Sakha, M.; Nasiri, E.; Zahirian Moghadam, T. Nursing work intention, stress, and professionalism in response to the COVID-19 outbreak in Iran: A cross-sectional study. Work 2021, 68, 969–979.
  20. Huang, L.; Lin, G.; Tang, L.; Yu, L.; Zhou, Z. Special attention to nurses’ protection during the COVID-19 epidemic. Crit. Care 2020, 24, 120.
  21. McGilton, K.S.; Krassikova, A.; Boscart, V.; Sidani, S.; Iaboni, A.; Vellani, S.; Escrig-Pinol, A. Nurse Practitioners Rising to the Challenge During the Coronavirus Disease 2019 Pandemic in Long-Term Care Homes. Gerontologist 2021, 61, 615–623.
  22. Kim, H.; Choi, E.; Park, S.; Kim, E. Factors Influencing Preventive Behavior against Coronavirus Disease 2019 (COVID-19) among Medically Inclined College Students. J. Korean Acad. Fundam. Nurs. 2020, 27, 428–437.
  23. Liu, S.Y.; Kang, X.L.; Wang, C.H.; Chu, H.; Jen, H.J.; Lai, H.J.; Shen, S.H.; Liu, D.; Chou, K.R. Protection procedures and preventions against the spread of coronavirus disease 2019 in healthcare settings for nursing personnel: Lessons from Taiwan. Aust. Crit. Care 2021, 34, 182–190.
  24. González-Gil, M.T.; González-Blázquez, C.; Parro-Moreno, A.I.; Pedraz-Marcos, A.; Palmar-Santos, A.; Otero-García, L.; Navarta-Sánchez, M.V.; Alcolea-Cosín, M.T.; Argüello-López, M.T.; Canalejas-Pérez, C.; et al. Nurses’ perceptions and demands regarding COVID-19 care delivery in critical care units and hospital emergency services. Intensive Crit. Care Nurs. 2021, 62, 102966.
  25. Kavanagh, K.T.; Pare, J.; Pontus, C. COVID-19: Through the eyes through the front line, an international perspective. Antimicrob. Resist. Infect. Control. 2020, 9, 179.
  26. Shon, C. The Response of the Seoul Municipal Hospitals against COVID-19 and Its Implications for Public Hospitals. Korea J. Hosp. Manag. 2020, 25, 38–52.
  27. Park, B.J. Epidemiological Characteristics of COVID-19 and Effective Preparation for the Second Outbreak. J. Health Tech. Assess. 2020, 8, 1–8.
  28. Kim, J. Ipmlication of the COVID-19 pandemic on health equity and healthy cities. Korean J. Health Educ. Promot. 2020, 37, 81–89.
  29. Alberti, P.M.; Lantz, P.M.; Wilkins, C.H. Equitable pandemic preparedness and rapid response: Lessons from COVID-19 for pandemic health equity. J. Health Politics Policy Law 2020, 45, 921–935.
  30. Mena, G.E.; Martinez, P.P.; Mahmud, A.S.; Marquet, P.A.; Buckee, C.O.; Santillana, M. Socioeconomic status determines COVID-19 incidence and related mortality in Santiago, Chile. Science 2021, 372, eabg5298.
  31. Chowkwanyun, M.; Reed, A.L. Racial Health Disparities and Covid-19—Caution and Context. N. Engl. J. Med. 2020, 383, 201–203.
  32. Kim, E.A. Social Distancing and Public Health Guidelines at Workplaces in Korea: Responses to Coronavirus Disease-19. Saf. Health Work 2020, 11, 275–283.
  33. Kwon, S. For a sustainable COVID-19 response policy. Korean J. Public Health 2020, 57, 25–37.
More