Health systems need to be better than pre-pandemic levels, say experts

As global health systems begin to address the long-term effects of the COVID-19 pandemic, particularly regarding backlogs and waiting times, experts have warned that simply returning to pre-pandemic levels of healthcare will not be enough.

“A major concern since the onset of the pandemic has been the pandemic’s impact on countries’ capacity to maintain essential health care,” said Hans Kluge, director of the World Health Organisation’s (WHO) regional office for Europe, as he commented on a WHO policy brief regarding backlogs and waiting lists released on Wednesday (6 July).

Kluge highlighted how over 90% of the WHO European region countries reported disruptions to essential health services in 2020, leading to growing backlogs and waiting lists.

“For each person who cannot receive care when they need it, this delay may have severe consequences, ranging from worsening health problems and prolonging recovery to decreasing quality of life,” he added.

In many contexts, including in the EU, debates focus on bringing things back to pre-pandemic status. Given the extent of the challenges, that will not be sufficient, warned Ewout van Ginneken, co-author of the policy brief from the European Observatory on Health Systems and Policies, Nuffield Trust and WHO Europe.

“Bringing care back to previous levels before the epidemic will not be enough to overcome the backlogs. We have pre-pandemic waiting times that are quite severe in several countries. And that number only started to increase during the pandemic,” he said during the discussion of the policy brief.

The countries trying to address the backlogs are broadly using three strategies, according to the brief. These are increasing the supply of workforce and staffing; improving productivity, capacity management and demand management; and investing in capital, infrastructure and new community-based models of care.

While this may be part of the solution, there is a broad consensus amongst experts and stakeholders that more is needed. Especially since many aspects of the full impacts of the COVID-19 crisis on healthcare systems remain unknown.

Knowledge of the exact size of the backlogs is also unknown. On top of that, the amount of “missing patients” – the ones who were expected to need diagnostics and treatments but did not get them – is uncertain.

At the same time, the health workforce is chronically overstretched and unprotected from severe burnout. As EURACTIV previously reported, health professionals fear that the demand over the summer will overwhelm capacity.

Need for reliable data on backlogs to invest

In most EU countries, health spending has declined since 2019, according to the Organisation for Economic Co-operation and Development (OECD).

Yet, investments into health systems are needed to make them more resilient and clear the ever-increasing backlogs. For that we need reliable data, said Natasha Azzopardi-Muscat, director of the WHO’s division of country health policies and systems.

“What is not measured is not visible, it is that simple,” she said during the discussion. “We need to know where the problem lies – in which areas, which sectors, which specialities, how large the problem is […] and so on.”

During the pandemic there has been more focus on the improvement of disease surveillance data, with increased political support to extend the mandates of agencies such as the European Centre for Disease Prevention and Control (ECDC), to enable them to better monitor the spread of COVID-19 and other diseases.

“There are still countries without knowledge about [backlogs and waiting times]. It’s not only the availability of data, it’s also the quality of data,” said Pascal Garel, CEO of the European Hospital Federation (HOPE), recalling problematic discussions at the beginning of the pandemic about ICU bed numbers, disturbed by data based on different indicators.

Availability and quality of data also affect workforce planning with “no workforce planning in most countries because there’s no information [on how to do it],” according to Garel.

European hospitals generally face a lack of health professionals, which existed well before the COVID-19 pandemic, Isabelle Marchais, a researcher associated with the Jacques Delors Institute in health policy, told EURACTIV in an interview in June.

Healthcare workers are often pressed by low pay, working overtime and a lack of labour recognition, all worsened by the pandemic and the cause of the widespread recruitment and retention issues.

“Every country across the [WHO Europe region] has placed workforce shortages as the most difficult policy issue they’re struggling with at the moment,” Azzopardi-Muscat said, who also recommended better accessibility of mental health services for health care workers.

[Edited by Gerardo Fortuna/Nathalie Weatherald]