The Perfect Enemy | Long-COVID patients more likely to report unmet healthcare needs
April 15, 2024

Long-COVID patients more likely to report unmet healthcare needs

The consequences of unmet care needs may include an increased risk of disability and lower health-related quality of life.

Adult long-COVID patients were more likely than COVID-19 patients without persistent symptoms and uninfected adults to report unmet healthcare needs in the past year due to factors such as cost, difficulty finding providers accepting new patients, and getting a timely appointment and insurance authorization, according to a study published yesterday in JAMA Network Open.

Researchers at the Urban Institute in Washington, DC, analyzed data from the online Health Reform Monitoring Survey from June 17 to July 5, 2022, among 9,484 US adults aged 18 to 64 years. The average age was 41.0 years, 50.6% were women, 58.9% were White, 19.1% were Hispanic, 12.7% were Black, 6.3% were Asian, and 3.0% were of another race.

Long COVID was defined as having symptoms for more than 4 weeks after a positive test that didn’t have another explanation. The researchers said the study was the first to address the ability to access and pay for healthcare among working-age long-COVID patients.

Problems with access, insurance

Of the 9,484 respondents, 3,382 reported ever being infected with SARS-CoV-2 (36.4%), and 833 (22.5%) said their symptoms lingered for at least 4 weeks. A total of 54.1% and 16.1% of these patients said their symptoms reduced their ability to perform daily activities a little or a lot, respectively. Among all respondents, 610 (16.2%) reported symptoms persisting for 3 months or more.

Adjusted results showed that the 833 participants with long COVID were more likely than the 2,549 adults who tested positive for SARS-CoV-2 but reported no lingering symptoms and 6,102 COVID-naïve adults to report healthcare access and affordability issues.

Long-COVID participants were more likely than ever- and never-infected patients to attribute a lack of access to costs (27.0% vs 18.3% and 17.5%, respectively), problems finding clinicians accepting new patients (16.4% vs 10.1% and 10.7%), securing a timely appointment (22.0% vs 14.4% and 13.9%), getting to a clinic when it was open (11.0% vs 5.3% and 6.7%), getting a telehealth visit (7.6% vs 3.1% and 4.0%), receiving health insurance authorization (16.6% vs 10.8% and 10.3%), finding a doctor accepting their insurance (15.9% vs 9.6% and 10.0%), and getting information from their plan about healthcare networks, covered services, or cost of care (13.6% vs 7.6% and 8.6%).

Participants with long COVID were more likely than other ever-infected adults to have gone without care because they couldn’t find transportation (6.1% vs 3.5%) but were not significantly more likely to report this experience than never-infected adults, who had a 5.1% rate. Nearly 1 in 4 respondents with long COVID reported difficulty paying family medical bills in the past year (23.5%) and satisfying past-due medical debt (23.8%), compared with fewer than 1 in 6 adults with no long-term symptoms.

Higher risk of poor outcomes

Among adults insured in the past 12 months, those with long COVID said they had more problems using their health plans, and women had a higher rate of long COVID (65.4%, vs 48.3% and 49.7% of the other two groups). Likewise, long-COVID patients were also more likely to be Hispanic than those in the other two groups (28.7% vs 18.7%, respectively) and to have other chronic conditions, similar to findings of previous studies.

Nearly 1 in 4 respondents with long COVID reported difficulty paying family medical bills in the past year and satisfying past-due medical debt, compared with fewer than 1 in 6 adults with no long-term symptoms.

Long-COVID patients were less likely to have health insurance coverage in all months of the past year (81.9%) than those with COVID-19 diagnoses but no persistent symptoms (89.1%) and had similar past-year coverage as never-infected respondents (82.3%).

The researchers called for policies designed to improve healthcare access and affordability focused on accelerating the development of therapies and clinical guidelines, training providers, and reducing insurance and cost barriers.

“The consequences associated with unmet medical needs may include exacerbated risk of disability and reduced health-related quality of life,” they wrote. “Access to timely and effective treatment may be especially important for maintaining employment.”