With more health resources for COVID-19, non-COVID patients may have unmet health needs that predict worse health in the future. Image Credit: Shutterstock

Since the second wave of COVID-19 has now officially reached central Canada (Québec and Ontario), we can assume that the resources of the health system will again be disproportionately in demand from COVID-19 patients. Addressing the direct health effects of the pandemic is clearly necessary, but it can have indirect costs for non-COVID patients who may have difficulty accessing the care they need.

To meet these unmet health care needs, policies are needed, such as: These include better data, aligning medical bills with telemedicine, including increased hours, and making sure all Canadians receive regular care.

As a health economist and health policy researcher, I regularly analyze how the organization of health systems affects health care and health outcomes. In a recent article, my co-author Ian Allan and I examined the evolution of unmet health needs in Canada since the early 2000s. We found remarkable stability over a 14-year period in the groups reporting comparatively unmet health needs: women, people in poor health, and people without a regular doctor.

Unmet needs

Unsatisfied health needs reflect an inadequacy between the needs of people seeking medical care (the patients or those trying to become someone’s patient) and the health services actually received, making them a measure of the inaccessibility of care . While they are typically self-reported, unmet health needs are a commonly used and valid measure as higher unmet health needs in the present predict poorer health in the future. And these unmet health needs are expected to increase during the COVID-19 pandemic.

The negative effects of the COVID-19 pandemic on women are far-reaching, including the fact that the hardest-hit industries tend to employ more women or that the lion’s share of household responsibility during and after the lockdown still falls on women.

Unfortunately, women in Canada are also more likely than men to report unmet health needs. We have also found that over time, more women are reporting unmet needs for systemic reasons. Excessive waiting times and areas where care is not available are examples of systemic causes that health policy could address.

People in poorer health, like people with chronic illnesses, face a double-edged sword with COVID-19. On the one hand, they are more likely to develop severe forms of COVID-19 if they become infected. This gives them an incentive to limit social exposure, including exposure to health care providers and clinical settings. On the other hand, if their conditions are not properly managed and monitored, these individuals are likely to become more seriously ill, which requires contacts with the health system.

Again, people in poorer health consistently report higher unmet health needs than their healthier counterparts, meaning they are at a higher risk of inadequate care during the COVID pandemic.

For these two subsets above, and others as well, having a regular doctor will help ensure that individuals are getting the health care they need. However, Canada does not compare well with other developed countries when it comes to timely access to health services.

The lack of access to care is often related to Canada’s high proportion of unrelated patients (patients without a regular GP or other primary care provider). About 15 percent of Canadians are in this situation. What’s worse is that in Québec, the province hardest hit by COVID-19, nearly 22 percent don’t have a regular care provider.

Targeted solutions

Targeting these sub-groups should be part of the policy package to study the impact of COVID-19. Ensuring that all Canadians have a regular care provider needs to be a top priority even when it comes to politics and political agendas, although it is not strictly necessary that the primary care provider be a doctor.

Efforts to address this problem, such as creating a central waiting list, have shown mixed effectiveness. During COVID-19, the speeding up of formal GP registration for those on a central waiting list in Québec is going in the right direction. However, this only works if patients can visit the clinic.

The use of telemedicine has grown significantly during the pandemic, and while it may have helped people with chronic illnesses, one problem is that there were differences in how telemedicine practices were included in doctors’ billing plans across provinces. In Ontario, the other hard-hit province, more billing-related complications may have placed some clinics in dire financial straits and, in turn, compromised access to care. And the telemedical approach should only support better access to care for women if it is combined with access outside of business hours and on weekends due to their normally higher family responsibilities.

Data gaps

Overall, the effects of late care should not be underestimated. For example, non-urgent procedures and elective surgery in Ontario have been postponed for more than two months, and the queue builds as new and postponed patients seek care.

One problem is that in Canada we don’t know exactly how much care has been postponed or given up. Other countries such as France and the United States may publicly report this information.

As data advances and greater coordination between provinces on the way, Canada needs better infrastructure and a better health data reporting system, not only to cope with the pandemic but also to ensure that everyone’s health needs are met.

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Quote: Collateral Damage: The unmet health needs of non-COVID-19 patients (2020, October 27th) was discovered on October 27th, 2020 from https://medicalxpress.com/news/2020-10-collateral-unmet-health-care- retrieved. non-covid-patient.html

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