According to new findings, adult patients with post-COVID-19 illness (PCC), commonly referred to as “long COVID-19”, are more likely to experience difficulty accessing and paying for health care than those who don’t.1
In a new analysis of US survey data, patients whose SARS-CoV-2 infection progressed to CCP were more likely to report problems with unmet healthcare needs, finding a clinician available and receive clearance for health plan care than patients who had COVID-19 without progressing to long-term burden.
The findings elucidate the systemic struggles to respond to CCP, a condition that may affect up to 1 in 5 people infected with the pandemic virus who are currently without regulated therapies or routinely recommended treatment regimens for affected patients.2
A research team led by Michael Karpman, MPP, of the Health Policy Center at the Urban Center in Washington D.C., sought to examine health care access and affordability as it relates to CCP among adult patients in the United States. . Prior to their assessment of nationally representative survey data from July 2022, there was no known published research of its kind that investigated the association between long COVID-19 and accessibility challenges. taking care.
“Experiences of patients with similar and overlapping conditions, such as myalgic encephalomyelitis/chronic fatigue syndrome, suggest that American patients with PCC may have difficulty navigating a fragmented healthcare system,” wrote the investigators. “Potential barriers to care include difficulty finding available and accessible clinicians, lack of coordination of care, clinician attitudes toward or lack of knowledge about the disease, denial of health insurance claims for testing and salaries, and high disbursements.”
With the consequences of unmet care needs, including increased risk of disability and overall deterioration in quality of life, it is critical that clinicians interpret PCC patients’ access to timely and effective treatments.
Karpman and his colleagues used data from the Health Reform Monitoring Survey, an online questionnaire that collected thousands of contributions from American adults from June to July 2022. The team looked for patients with self-reported long COVID-19, defined as having unexplained symptoms ≥ 4 weeks after first diagnosis of COVID-19 – aged 18-64. Their primary outcomes included patient access to usual place of care; their need to forego care in the past 12 months due to cost, difficulty finding a clinician, or difficulty with health insurance coverage; difficulty paying family medical bills in the past 12 months; and accumulated outstanding medical debt.
The survey recruited 19,162 panel members, of whom 9,599 completed it and 9,484 were included in the surveyors’ final evaluation. The average age of respondents was 41.0 years; 50.6% were female and 58.9% were white. About a third (36.4%) of respondents had previously been diagnosed with COVID-19; of these, 22.5% reported having PCC symptoms for >4 weeks and 16.2% reported having such symptoms for >3 months.
As was consistent with previous data,3 adults with PCC were more likely to be female (65.4%) or Hispanic (28.7%) than those with a COVID-19 diagnosis or those never diagnosed.
About two-thirds (62.9%) of adults with PCC reported that a clinician had ever diagnosed ≥1 of the physical health conditions studied. However, the same population was less likely to be insured in the past year than adults with only one diagnosis of COVID-19 or adults without either diagnosis.1
Adults with PCC were also more likely to report difficulties in the past 12 months due to costs (27.0%), difficulty finding clinicians to accept new patients (16.4%), getting a timely appointment (22.0%) and getting health plan approval (16.6%) than adults with only a diagnosis of COVID-19 or no diagnosis at all (P <.001).
Karpman and colleagues noted that although a majority of patients with long-term COVID-19 reported having a familiar health care source, some may be troubled to find a clinician who is knowledgeable about their condition and its symptoms.
“Additionally, some patients may not have been aware of or had access to a multidisciplinary PCC clinic,” the investigators wrote. “Because PCC is an emerging chronic disease, many clinicians may be limited by a lack of evidence on diagnostic tests and effective treatments, which may be associated with an increased likelihood of referring patients to 1 or more specialists with limited availability.”
Indeed, long COVID-19 caregivers like Marc A. Sala, MD, co-director of the Northwestern Medicine Comprehensive COVID Center have previously said HCP Live that the evidence base for any potential treatment for CCP is “probably dismal” and that some currently adopted methods of care are supported by “a “very unfounded biology” as he and his colleagues work to define an optimal care team for these patients in need.2
“What we’ve found is that while most people need to see more than one specialist to treat their symptoms, not everyone needs to see every specialist,” Sala said. “When we look at our data, we found that most people saw 2 more specialists, and it was rarely the same.”
The investigators concluded that their survey analysis showed greater barriers to health care access and affordability for patients with self-reported PCC – challenges that could eventually lead to health deterioration in the long run. term and reduced labor and personal capacity of untreated patients.1
“Policymakers may be able to expand access to care by accelerating research into PCC treatments, disseminating clinical care guidelines, and regulating insurance practices,” they wrote.
- Karpman M, Zuckerman S, Morriss S. Health care access and affordability among US adults ages 18-64 with self-reported post-COVID-19 condition. JAMA Netw Open. 2023;6(4):e237455. doi:10.1001/jamanetworkopen.2023.7455
- Kunzmann K. No one is left behind: the long COVID crisis in 2023. HCPLive. Published March 27, 2023. Accessed April 10, 2023. https://www.hcplive.com/view/no-one-left-behind-the-long-covid-crisis-2023
- Kunzmann K. Long Risk of COVID-19 linked to women, older age and higher BMI. HCP Live. Published March 26, 2023. Accessed April 10, 2023. https://www.hcplive.com/view/long-covid-19-risk-linked-women-older-age-higher-bmi