In the wake of the COVID-19 pandemic, healthcare has circled back to the house calls of the early 20th century.
Robert Havasy
Senior Connected Health Director, HIMSS
I’m old enough that many TV shows throughout my childhood showed doctors making house calls. From “I Love Lucy” to “Marcus Welby, M.D.,” the doctor came to your home, unless you were dying. And even then, he (it was always he) visited the patient in the hospital and personally directed their care.
My own experience reversed this home-based paradigm. My pediatrician and childhood dentist both practiced in converted first floors in residential homes on neighborhood streets, not in fancy office buildings. It wasn’t until I was 18 and in college that I visited my first purpose-built medical office. And I was raised in New Jersey, not some rural hinterland. Until the middle of the 20th century, this was the norm. By the 1940s, house calls still accounted for 40 percent of physician visits and didn’t begin a rapid decline until the 1960s.
Care economics
So, what happened to the house call? Technology, in some ways, made it impractical. As medical equipment advanced, the gap between what a doctor could bring to a home in a little black bag and what they could do in a dedicated office widened until house calls no longer made sense for managing some conditions.
The economics of healthcare also changed. According to National Health Expenditure, data maintained by the Centers for Medicare & Medicaid Services, the out-of-pocket share of total healthcare costs declined from almost 70 percent in 1960 to only 9 percent in 2020. To put it plainly, doctors do what is convenient for the people paying them. When patients paid the doctor directly, the doctor visited them. Doctors did what the new payers wanted when insurers started writing the checks. That meant increasing efficiency by having doctors stay in one place and making patients come to them.
A new era of medicine
At the beginning of 2022, we are again talking about care moving back to the home. Only this time, we are using terms like hospital-at-home and telemedicine. In most healthcare circles, this is discussed as a technology-driven change that involves providing some acute-care services in patient homes. It is primarily attributed to COVID-induced capacity shortages of hospital beds and healthcare providers. It means that some of those machines and procedures that are only found in hospitals today will move to your home. Does this signal a return to the house calls of the past?
There is an underlying trend in care economics that may accelerate the movement of some care back to the home and give it staying power beyond the pandemic. America is again shifting toward more self-directed healthcare spending. The growth in high-deductible health plans and the increasing use of health savings accounts is give spending power back to individuals, and many individuals are asking for more convenience in their care experiences. The growth and acceptance of telemedicine, home-based diagnostic testing, and other virtual services driven by COVID-19 means that, unlike the quaint scenes that played out on black and white televisions with the doctor knocking on the front door, the house call of the future will be virtual and quite common.