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Hospitals Reported That the COVID-19 Pandemic Has Significantly Strained Health Care Delivery


This review provides a national snapshot, from the perspective of front-line hospital administrators, on how responding to the COVID-19 pandemic has affected their capacity to care for patients, staff, and communities. This is not a review of the HHS response to the COVID-19 pandemic. We conducted our first pulse survey of challenges that hospitals reported facing in response to COVID-19 during the early weeks of the pandemic (March 23-27, 2020). This snapshot from 2021 provides HHS and other decisionmakers with updated information on hospital perspectives.


This report is based on a pulse survey conducted during February 22–26, 2021, with hospital administrators from 320 hospitals across 45 States, the District of Columbia, and Puerto Rico. Interviews focused on three key questions:

  1. What are your most difficult challenges in responding to the COVID-19 pandemic right now, and what strategies have you been using to address the challenges?
  2. What are your organization's greatest concerns going forward?
  3. How can government best support hospitals?


In February 2021, hospitals reported that operating in "survival mode" for an extended period of time has created new and different problems than experienced earlier in the pandemic and exacerbated longstanding challenges in health care delivery, access, and health outcomes.

Hospital-Reported Challenges. Hospitals described difficulty balancing the complex and resource-intensive care needed for COVID-19 patients with efforts to resume routine hospital care. They reported that staffing shortages have affected patient care, and that exhaustion and trauma have taken a toll on staff's mental health. Administrators detailed challenges associated with vaccine distribution efforts and concerns about vaccine hesitancy among staff and members of their communities. Hospitals also raised concerns that the pandemic has exacerbated existing disparities in access to care and health outcomes. Additionally, many hospitals reported experiencing financial instability because of increased expenses associated with responding to a pandemic and lower revenues from decreased use of other hospital services. Hospitals indicated that many of the challenges were more severe for rural hospitals.

Addressing Hospital Challenges. Hospitals reported a range of strategies to address their challenges and identified areas in which further government support could help as they continue responding to the pandemic. Broadly, the areas of government support included enhancing knowledge and guidance on the prevention and treatment of COVID-19, including safe means to discharge patients with COVID-19; helping to fill gaps in hospital staffing, especially for nurses and certain specialists; continuing financial relief, especially to increase care to rural and underserved communities; and, encouraging widespread vaccinations to reduce the circulation of the virus.

Looking Forward. Beyond the immediate needs in responding to COVID-19, the pulse survey documents hospitals' perspectives about longer-term opportunities for improvement to address challenges that existed before, and were exacerbated by, the pandemic. These improvements include reducing disparities in access to health care and in health outcomes, building and maintaining a more robust health care workforce, and strengthening the resiliency of our health care system to respond to pandemics and other public health emergencies and disasters.