Department of Health Economics, Justus Liebig University, Giessen, Germany.
BMC Health Serv Res. 2021 Oct 11;21(1):1076. doi: 10.1186/s12913-021-07094-9.
International healthcare systems face the challenge that waiting times may create barriers to accessing medical care, and that those barriers are unequally distributed between different patient groups. The disruption of healthcare systems caused by the COVID-19 pandemic could exacerbate this already strained demand situation. Using the German healthcare system as an example, this study aims to analyze potential effects of the COVID-19 pandemic on waiting times for outpatient specialist care and to evaluate differences between individual patient groups based on their respective insurance status and the level of supply.
We conducted an experiment in which we requested appointments by telephone for different insurance statuses in regions with varying levels of supply from 908 outpatient specialist practices in Germany before and during the COVID-19 pandemic. Data from 589 collected appointments were analyzed using a linear mixed effect model.
The data analysis revealed two main counteracting effects. First, the average waiting time has decreased for both patients with statutory (mandatory public health insurance) and private health insurance. Inequalities in access to healthcare, however, remained and were based on patients' insurance status and the regional level of supply. Second, the probability of not receiving an appointment at all significantly increased during the pandemic.
Patient uncertainty due to the fear of a potential COVID-19 infection may have freed up capacities in physicians' practices, resulting in a reduction of waiting times. At the same time, the exceptional situation caused by the pandemic may have led to uncertainty among physicians, who might thus have allocated appointments less frequently. To avoid worse health outcomes in the long term due to a lack of physician visits, policymakers and healthcare providers should focus more on regular care in the current COVID-19 pandemic.
国际医疗体系面临的挑战是，等待时间可能会成为获得医疗服务的障碍，而且这些障碍在不同患者群体之间分布不均。COVID-19 大流行对医疗体系的破坏可能会使本已紧张的需求状况进一步恶化。本研究以德国医疗体系为例，旨在分析 COVID-19 大流行对门诊专科治疗等待时间的潜在影响，并根据各自的保险状况和供应水平，评估不同患者群体之间的差异。
我们在 COVID-19 大流行之前和期间，通过电话在德国 908 家门诊专科诊所为不同保险状况的患者预约，并在不同供应水平的地区进行了一项实验。使用线性混合效应模型分析了 589 次预约中收集的数据。
数据分析揭示了两个主要的反作用效应。首先，法定（强制性公共健康保险）和私人医疗保险患者的平均等待时间都有所缩短。然而，医疗保健的可及性不平等仍然存在，并且基于患者的保险状况和地区供应水平。其次，在大流行期间，根本无法预约的概率显著增加。
由于担心潜在的 COVID-19 感染，患者的不确定性可能使医生的诊所腾出了容量，从而缩短了等待时间。与此同时，大流行引起的特殊情况可能导致医生感到不确定，从而减少了预约的频率。为了避免由于缺乏医生就诊而导致长期健康状况恶化，政策制定者和医疗保健提供者在当前 COVID-19 大流行期间应更加关注常规护理。
