Health services during Covid-19: What do we know of the degree of service disruption and size of the backlogs?

Abstract Since the onset of the COVID-19 pandemic, there have been concerns that shifting health system capacities towards acute COVID-19 cases can affect the provision of non-COVID-19 essential health services, causing severe disruptions and lack of care. Examples of this have been seen during other epidemic outbreaks, such as the 2014-2016 Ebola outbreak in West Africa. To capture the degree of service disruption across the European and Central Asian region, we analysed data from the World Health Organization's Pulse Survey on the Continuity of Essential Health Services, conducted in three rounds in 2020 and 2021. The key findings include: – Health service provision has been heavily disrupted in virtually all countries. 91% of countries reported service disruptions in late 2021, indicating that health services continue to be disrupted at large scale. – Service discontinuation has been substantial across all levels of care and in most service areas, often resulting in delays and cancellations of elective and emergency procedures, routine visits, prescription renewals, and referrals to specialty care. This has led to growing backlogs and record waiting times for services. – Countries have been affected to varying degrees and report different levels of service disruption, size of the backlog, recovery of services aiming for pre-pandemic levels, and interventions to manage waiting lists. The findings indicate that even as health systems are better learning to care for acute COVID-19 patients, the pandemic's impact on essential health services is massive and likely to affect the care for people's health and well-being post the acute phase of the public health emergency. Measuring the size of backlogs and implementing innovative care solutions are urgent and paramount.

As COVID-19 cases started to rise in early 2020 and hospitalisation rates increased, health systems began to postpone non-emergency (elective) procedures to keep capacity available for COVID-19 patients, and to avoid elective patients being infected. This has subsequently led to longer waiting lists and waiting times in virtually all countries. Issues around staff recruitment and retention, which have been exacerbated by the COVID-19 pandemic, have further aggravated the problem. For patients with common elective surgeries, such as hip and knee replacements, the backlog in care means that improvements in health and quality of life are postponed. For urgent care, such as missed chemotherapy sessions for cancer care, the delays can have more severe consequences. For other patients, the postponement of specialist appointments may lead to missed referrals for serious ailments. Increasingly also primary care has become affected leading to late diagnosis of chronic diseases, as well as inadequate follow up and control of these patients. Each delay in diagnosis and treatment may worsen health problems, prolong recovery and decrease the patients' chances of survival. Countries are now left playing catch-up on these backlogs. There is however great uncertainty regarding the size of the backlogs, how much current and future capacity will be required to address them, and how much provider and workforce capacity will be needed for COVID-19 patients which will detract capacity for non-COVID patients. If health systems do not manage to reduce the backlog, they risk worsening health outcomes and wasting important health gains made in the last years. This workshop will discuss what we know about (1) the level of service disruptions and resulting backlog, (2) the drivers of backlog, and (3) which policies countries are using to address this. The workshop will conclude with an audience discussion about how to measure the true size of the backlog, the policy options for overcoming backlog and key priorities for further research.

Key messages:
The COVID-19 pandemic has led to substantial disruptions in care delivery leading to care backlogs in virtually all countries.
Countries have various policy options to tackle backlogs and bring down waiting times in the wake of the pandemic. -Service discontinuation has been substantial across all levels of care and in most service areas, often resulting in delays and cancellations of elective and emergency procedures, routine visits, prescription renewals, and referrals to specialty care. This has led to growing backlogs and record waiting times for services.
-Countries have been affected to varying degrees and report different levels of service disruption, size of the backlog, recovery of services aiming for pre-pandemic levels, and interventions to manage waiting lists.
The findings indicate that even as health systems are better learning to care for acute COVID-19 patients, the pandemic's impact on essential health services is massive and likely to affect the care for people's health and well-being post the acute phase of the public health emergency. Measuring the size of backlogs and implementing innovative care solutions are urgent and paramount.
Abstract citation ID: ckac129.211 What are the drivers of waiting times, waiting lists and backlog during and following the COVID-19 pandemic?
Luigi Siciliani The COVID-19 pandemic put a halt to the number of patients being treated thus generating larger excess demand and a greater mismatch between demand for health care services and the supply of services provided. This presentation will provide a conceptual framework for understanding the dynamic interrelation between waiting times, waiting lists and the backlog over time. Data from different countries will be used to illustrate and rationalise how waiting times, lists and volumes evolved over time. It will then discuss factors driving the demand and supply of care during Covid, and emphasise the critical role of supply in absorbing the backlog and reducing the waiting list under different scenarios, as well as factors on the demand side both in the short run and the long run. Supply determinants include the availability of health workers as key factor to ''bounce back'', their productivity and provider capacity (hospital beds, operating theatres), the cost of providing treatment in a safe environment, financial capacity to fund additional supply both by public and private providers, interventions to minimise staff exhaustion and burnout, payment systems which are aligned with higher volumes, and technologies and digital solutions. Demand determinants include ageing and rising chronic conditions, and multi-morbidity patients (including long-COVID patients), increasing expectations, new technologies, prioritisation protocols, but also fear of infection which can leading to a iii88 European Journal of Public Health, Volume 32 Supplement 3, 2022