A crisis like no other? Unmet needs in healthcare during the first wave of the COVID-19 crisis in Austria

Abstract

Background: Many patients experienced restricted access to healthcare during the Coronavirus Disease 2019 (COVID-19) pandemic. This study is among the first to provide systematic evidence on the existence of subjective unmet needs (SUN) in different population groups during the pandemic.

Methods: Using data on individuals aged 20-64 and living in Austria from the AKCOVID survey (June 2020) and the 'European Social Survey' (2015), SUN were compared between 2015 and 2020, either related to the pandemic (fear of infection, provider closed or treatment postponed) or not (barriers related to knowledge, affordability, time and reachability). Multinomial logistic regression models identified determinants of SUN during the pandemic, adjusting for socio-demographics, socio-economic status and self-reported health.

Results: Shares of the population with SUN in 2020 substantially exceeded SUN in 2015. Excess unmet needs were mostly attributable to the pandemic. Postponed treatments and closed providers were the most important reasons for SUN in June 2020. Older age groups (50-64 years), inactive and retired people were most likely to report pandemic-related SUN. We did not find socio-economic differences in pandemic-related SUN.

Conclusions: The pandemic resulted in a supply-side shock to healthcare, with vulnerabilities emerging especially among older people, people with poor health and/or people no longer active on the labour market. Further research could focus on health system resilience and the possibilities to improve management of healthcare services during pandemics without widening inequalities while maintaining population health.

Figure 1

Predicted probabilities based on multinomial logistic regressions according to Model 1 (including ‘no needs’ category) (upper panel) and Model 2 (excluding ‘no needs’ category) (lower panel) Reading example: women have a significantly higher probability than men to report pandemic-related SUN. Their probability is 4.3 percentage points higher (i.e. the difference between the predicted probability for men, and the predicted probability for women). Note: See Supplementary materials online for further detailed calculations of average marginal effects. *P ≤ 0.05; **P ≤ 0.01; ***P ≤ 0.001. SRH, self-rated health; SUN, subjective unmet needs.

Figure 2

Predicted probabilities to report SUN related to the pandemic by SRH status and age (left panel), and by SRH status and financial well-being (right panel) SRH, self-rated health.