What are the drivers of waiting times, waiting lists and backlog during and following the COVID-19 pandemic?

Abstract 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 temporary or permanent reduction in demand but an increase in unmet need. The framework will be used to discuss policy options both on the demand and the supply side to deal with the backlog, but also to improve the resilience and efficiency of health systems.

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. 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 temporary or permanent reduction in demand but an increase in unmet need. The framework will be used to discuss policy options both on the demand and the supply side to deal with the backlog, but also to improve the resilience and efficiency of health systems. Many country responses display striking similarities despite very real differences in the organisation of health and care services. These include: 1) increasing the supply of workforce by widening the scope of authority for different roles, investing heavily in recruitment and training for key roles, and improving the terms and conditions of work; 2) boosting productivity by introducing financial incentives and targets, reconfiguring facilities to better separate planned and emergency work'', optimising referrals and waiting list management, and outsourcing more care to the private sector; and 3) investing in out-of-hospital alternatives to care, including expanding primary and community care models and developing digital, home care and rehabilitative capacity Policymakers will need to balance the immediate pressures of clearing backlogs with long-term measures that place services on a more sustainable footing. International experience shows how these can be at odds, especially if actions taken in the short term exhaust an already depleted workforce, or resolve Covid-19-specific problems but leave services less prepared for tomorrow's challenges.

4.C. Workshop: Promoting health without borders: cross-border public health policy in the Euregio Meuse-Rhine
Abstract citation ID: ckac129.213 For more than 20 years, different public health institutions in the German-Belgian-Dutch border triangle have been involved in cross-border public health activities. The partners in the Euregio Meuse-Rhine (EMR), as this area is called, have jointly implemented studies on COVID-19 and on adolescent risk behaviour. They have established joint health reporting for various purposes and implemented prevention measures together. The special problems in the border regions during the Corona pandemic have once again impressively shown how important cross-border cooperation is -also for cross-border public health policy. In the health sector, orientation towards municipal, state and federal borders does not lead to the desired results. The results of the Euregional COVID 19 study of 2021 show that in this way a 'borderless' life -and partly also crossborder health care -cannot be adequately served. In fact, in the everyday life of a border community, there is hardly any difference between a district border and a national border. In the EMR, this is exemplary for the entire European Union, with its many national or local responsibilities. For infectious diseases, lifestyle risks, environmental toxins or climate risks, borders have no meaning. For health, however, they do. Cross-border policy and politics is the appropriate response to real European conditions. The workshop will show the possibilities and results of cross-border policy on the basis of 3 examples from the longstanding cooperation of public health actors from the Euregio Meuse-Rhine. Finally, we will present these factors and put them up for discussion. From these and other activities, the factors that enable or hinder policy along borders can be deduced. We will present these factors, classify their significance and present the possibility of generalisation for cross-border work for discussion.

Key messages:
Cross-border policy and coordination are the appropriate responses to the current realities in the European Union. National differences in culture, administration and policy can be obstacles to cooperation; but are usually inspiration for new approaches and input for best practice. can participate. Pupils in the 8th and 10th grades are asked about various topics in an online questionnaire. These include: physical and emotional well-being, physical activity, nutrition, media behaviour, drug use and school behaviour. In 2019, 88 schools with more than 13,500 participants took part. With its cross-border approach, the study provides the opportunity to compare the living conditions, behaviour and health situation of pupils in the three countries. Ideally, this would result in common policy and prevention approaches and best practice options. For example, there are differences between the regions of the EMR regarding drug use or overweight, while risky media use is rather universal. It is striking that the Dutch participants almost consistently show the best values. It is also important to stress the importance of insight in policy along the border. Changes in policy actions have a huge effect on border regions. Examples are: The change in drinking age in the Netherlands: from 16 to 18 resulted in organizing their parties in the neighbouring countries.