Addressing backlogs and managing waiting lists during and beyond the COVID-19 pandemic [Internet]

Excerpt

1. COVID-19 meant non-emergency procedures were postponed which led to backlogs of care (and particularly hospital and specialist care) in virtually all countries. These jeopardize health outcomes.

2. Countries still struggle to understand the extent of backlogs but they are testing policies in practice and are generating lessons on what works.

3. Drivers that increase the backlog include:

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      Supply-side factors, such as: low numbers of health workers (even pre-COVID); lower productivity due to staff exhaustion; the extra cost of providing treatment safely; and weakened incentives for some care.

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      Demand-side factors include: new technologies; the ageing of the population and the rise of chronic conditions (including long COVID).

4. Drivers that decrease the backlog include:

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      Supply-side factors, such as: sufficient workforce and infrastructure; extra funding; and more efficient new technologies and digital solutions.

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      On the demand side, fear of infection may reduce demand, although this may also increase unmet need.

5. Restoring care to previous levels is not enough to overcome the backlogs but three broad groups of (overlapping) strategies are helping:

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      Increasing workforce and staffing with new professional roles and competencies; flexible recruitment and training; and improved work conditions and compensation.

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      Improving productivity, management of capacity and demand, separating planned and unplanned care; introducing tailored financial incentives; expanding access to telehealth; careful prioritization; and spreading patients to fit available capacity.

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      Investing in capital, infrastructure and new models of care, for example, by upgrading health facilities or digital infrastructure; investing in primary and community care; or expanding home care.

6. Policy-makers can reduce the risks associated with these strategies by:

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      Pairing improvements in workforce planning and availability with policies to support and protect health workers.

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      Monitoring policies to rationalize health care delivery, reduce waste or use digital solutions to ensure they do not (inadvertently) increase inequalities in utilization and health.