In fall of 2020, 25 percent of Canadians between the age of 45 and 85 had challenges accessing health-care services during the first nine months of the COVID-19 pandemic, and 8 percent of those studied did not go to a hospital or see a doctor when needed, according to a new study.
“Substantial unmet health care needs were reported by Canadian adults during the first year of the pandemic. The results of this study have important implications for health equity,” said the study, published in the Canadian Medical Association Journal (CMAJ) on Feb. 14.
Titled “Unmet health care needs during the COVID-19 pandemic among adults: a prospective cohort study in the Canadian Longitudinal Study on Aging,” the study considered 23,972 individuals who had participated in a study on aging conducted between April and December of 2020, and surveyed the individuals about their health-care experiences from September to December 2020.
The survey asked three questions to determine unmet health-care needs: “Since the beginning of the COVID-19 pandemic have you experienced any challenges in accessing health care?”; “Since March 1, 2020 were there times when you did not go to the hospital or to see a doctor even though you needed to?”; and “Since the beginning of the COVID-19 pandemic have you experienced barriers to accessing testing for COVID-19?”
If participants answered yes to the three unmet health-care questions, they were asked follow-up questions clarifying the services they had challenges accessing, the reasons they did not visit the hospital or see a doctor, and the barriers they faced when accessing testing for SARS-CoV-2 infection.
After surveying participants, the study found that immigrants and individuals with chronic conditions were more likely to have challenges obtaining health-care services, and were less likely to go to the hospital or see a doctor.
Chronic conditions included asthma; chronic obstructive pulmonary disease; other chronic lung diseases; diabetes; high blood pressure; heart disease; cancer; heart, lung, kidney, liver, or pancreas failure; autoimmune disorder; pneumonia; and human immunodeficiency virus.
The study noted that in 2020, due to COVID, elective surgeries and in-person appointments were cancelled and virtual medical visits increased. Emergency department visits declined by 24 percent, and inpatient admissions to hospital decreased by 10 percent. Public health measures disrupted home care and primary care services, it said.
“Unmet health care needs during the COVID-19 pandemic may have serious implications on patient care and potentially enduring consequences,” the study said. “Self-perceived unmet needs are a reflection of access to, and performance of, a health care system. Unmet needs are dependent not only on the use of services but also their accessibility and acceptability.”
People experienced different challenges depending on race, sex, age, education, income levels, the region they lived in, and immigrant status, the study found.
It noted older age was associated with less access to health care, for example, and those from lower income levels were less likely to visit the hospital or see a doctor when required. Females and non-Caucasian participants were also less likely to access medical care.
“Females were 13% more likely to indicate not seeking hospital or doctor attention,” it said, adding that non-Caucasian participants were less likely to have a regular family doctor.
Those who lived in Ontario reported the most challenges accessing health care and COVID testing. In that province, older adults were more likely to use virtual visits and drop visits with their doctor. Quebec residents were also most likely to not go to hospital or see their doctor, but did not struggle with the other two outcomes compared to other regions.
Four percent of participants reported having issues obtaining testing for SARS-CoV-2.
