{"id":70514,"date":"2020-10-26T13:17:34","date_gmt":"2020-10-26T17:17:34","guid":{"rendered":"https:\/\/newsroom.carleton.ca\/?post_type=cu_story&#038;p=70514"},"modified":"2025-08-19T09:37:19","modified_gmt":"2025-08-19T13:37:19","slug":"non-covid-19-patients-needs","status":"publish","type":"cu_story","link":"https:\/\/carleton.ca\/news\/story\/non-covid-19-patients-needs\/","title":{"rendered":"Collateral damage: The unmet health-care needs of non-COVID-19 patients"},"content":{"rendered":"\n<section class=\"w-screen px-6 cu-section cu-section--white ml-offset-center md:px-8 lg:px-14\">\n    <div class=\"space-y-6 cu-max-w-child-max  md:space-y-10 cu-prose-first-last\">\n\n        \n                    \n                    \n            \n    <div class=\"cu-wideimage relative flex items-center justify-center mx-auto px-8 overflow-hidden md:px-16 rounded-xl not-prose  my-6 md:my-12 first:mt-0 bg-opacity-50 bg-cover bg-cu-black-50 pt-24 pb-32 md:pt-28 md:pb-44 lg:pt-36 lg:pb-60 xl:pt-48 xl:pb-72\" style=\"background-image: url(https:\/\/carleton.ca\/news\/wp-content\/uploads\/sites\/162\/conversation-non-covid-19-patients-needs-1200w-1.jpg); background-position: 50% 50%;\">\n\n                    <div class=\"absolute top-0 w-full h-screen\" style=\"background-color:rgba(0,0,0,0.600);\"><\/div>\n        \n        <div class=\"relative z-[2] max-w-4xl w-full flex flex-col items-center gap-2 cu-wideimage-image cu-zero-first-last\">\n            <header class=\"mx-auto mb-6 text-center text-white cu-pageheader cu-component-updated cu-pageheader--center md:mb-12\">\n\n                                    <h1 class=\"cu-prose-first-last font-semibold mb-2 text-3xl md:text-4xl lg:text-5xl lg:leading-[3.5rem] cu-pageheader--center text-center mx-auto after:left-px\">\n                        Collateral damage: The unmet health-care needs of non-COVID-19 patients\n                    <\/h1>\n                \n                            <\/header>\n        <\/div>\n\n                    <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"absolute bottom-0 w-full z-[1]\" fill=\"none\" viewbox=\"0 0 1280 312\">\n                <path fill=\"#fff\" d=\"M26.412 315.608c-.602-.268-6.655-2.412-13.524-4.769a1943.84 1943.84 0 0 1-14.682-5.144l-2.276-.858v-5.358c0-4.876.086-5.358.773-5.09 1.674.643 21.38 5.84 34.646 9.109 14.682 3.59 28.935 6.858 45.936 10.449l9.874 2.089H57.322c-16.4 0-30.31-.16-30.91-.428ZM460.019 315.233c42.974-10.074 75.602-19.88 132.443-39.867 76.16-26.791 152.063-57.709 222.385-90.663 16.7-7.823 21.336-10.074 44.262-21.273 85.004-41.688 134.719-64.193 195.291-88.413 66.55-26.577 145.2-53.584 194.27-66.765C1258.5 5.626 1281.34 0 1282.24 0c.17 0 .34 27.596.34 61.3v61.299l-2.23.375c-84.7 13.718-165.93 35.955-310.736 84.931-46.494 15.753-65.427 22.076-96.166 32.15-9.102 3-24.814 8.198-34.989 11.574-107.543 35.954-153.008 50.422-196.626 62.639l-6.74 1.876-89.126-.054c-78.135-.054-88.782-.161-85.948-.857ZM729.628 312.875c33.229-10.985 69.248-23.523 127.506-44.207 118.705-42.223 164.596-57.709 217.446-73.302 2.62-.75 8.29-2.465 12.67-3.751 56.19-16.772 126.94-33.597 184.17-43.671 5.07-.91 9.66-1.768 10.22-1.875l.94-.161v170.236l-281.28-.054H719.968l9.66-3.215ZM246.864 313.411c-65.041-2.251-143.047-12.11-208.432-26.256-18.375-3.965-41.73-9.538-42.202-10.074-.171-.214-.257-21.38-.214-47.046l.129-46.618 6.654 3.697c57.313 32.043 118.491 56.531 197.699 79.143 40.313 11.521 83.459 18.058 138.669 21.059 15.584.857 65.685.857 81.14 0 33.744-1.876 61.306-4.93 88.396-9.806 6.396-1.126 11.634-1.983 11.722-1.929.255.375-20.48 7.769-30.999 11.038-28.592 8.948-59.288 15.646-91.873 20.147-26.36 3.59-50.015 5.627-78.35 6.698-15.584.59-55.209.59-72.339-.053Z\"><\/path>\n                <path fill=\"#fff\" d=\"M-3.066 295.067 32.06 304.1v9.033H-3.066v-18.066Z\"><\/path>\n            <\/svg>\n            <\/div>\n\n    \n\n    <\/div>\n<\/section>\n\n<p>As the second wave of COVID-19 has now officially hit Central Canada (<a href=\"https:\/\/www.cbc.ca\/news\/canada\/montreal\/quebec-second-covid-wave-presents-challegne-1.5734599\" target=\"_blank\" rel=\"noopener noreferrer\">Qu\u00e9bec<\/a> and <a href=\"https:\/\/news.ontario.ca\/en\/release\/58602\/ontario-releases-updated-covid-19-modelling-for-second-wave\" target=\"_blank\" rel=\"noopener noreferrer\">Ontario<\/a>), we can expect health-care system resources to again be disproportionally demanded by COVID-19 patients. Addressing the direct health implications of the pandemic is <a href=\"https:\/\/www.sciencemag.org\/news\/2020\/07\/brain-fog-heart-damage-covid-19-s-lingering-problems-alarm-scientists\" target=\"_blank\" rel=\"noopener noreferrer\">clearly necessary<\/a>, but doing so may come at an indirect cost for non-COVID patients who may struggle to access needed care. <\/p>\n\n\n\n<p>Meeting those unmet health-care needs calls for policy actions such as better data, alignment of physicians\u2019 billings with telemedicine, including extended hours, and ensuring all Canadians have a regular point of care.<\/p>\n\n\n\n<p>I am a health economist and health policy researcher, and in my work, I regularly analyze how the organization of health-care systems influence health care and health outcomes. In a recently <a href=\"https:\/\/doi.org\/10.1017\/S1744133120000250\" target=\"_blank\" rel=\"noopener noreferrer\">published article<\/a>, my co-author Ian Allan and I studied the evolution of unmet health-care needs in Canada since the early 2000s. We found a remarkable stability over a period of 14 years of the groups reporting comparatively more unmet health-care needs: women, those in poorer health and those without a regular doctor.<\/p>\n\n\n\n<h2 id=\"unmet-needs-for-non-covid-19-patients\" class=\"wp-block-heading\">Unmet needs for non-COVID-19 patients<\/h2>\n\n\n\n<p><\/p>\n\n\n\n<p>Unmet health-care needs reflect an inadequacy between the needs perceived by people seeking health care (the patients, or those trying to become someone\u2019s patient), and the actual health-care services received, making it a measure of <a href=\"https:\/\/doi.org\/10.1016\/j.socscimed.2009.10.027\" target=\"_blank\" rel=\"noopener noreferrer\">lack of accessibility of care<\/a>. While they tend to be self-reported, unmet health-care needs are a commonly used and a valid measure, since higher unmet health-care needs in the present <a href=\"https:\/\/doi.org\/10.1002\/hec.3877\" target=\"_blank\" rel=\"noopener noreferrer\">predict poorer health in the future<\/a>. And these unmet health-care needs are poised to grow during the COVID-19 pandemic.<\/p>\n\n\n\n<p>The negative implications of the COVID-19 pandemic for women are wide-ranging, including the fact that <a href=\"https:\/\/melbourneinstitute.unimelb.edu.au\/__data\/assets\/pdf_file\/0006\/3387039\/ri2020n10.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">industries hit hardest<\/a> tend to employ more women, or that the lion\u2019s share of <a href=\"https:\/\/www.ifs.org.uk\/publications\/14860\" target=\"_blank\" rel=\"noopener noreferrer\">household responsibilities<\/a> during and after lockdown still fell on women. <\/p>\n\n\n\n<p>Unfortunately, women in Canada are also more likely than men to report unmet health-care needs. We also found that over time, there has been an increasing share of women reporting unmet needs due to system reasons. Excessive wait times and areas where care is not available are examples of systemic causes that could be addressed by health policy.<\/p>\n\n\n\n<figure class=\"wp-block-image align-center\"><img decoding=\"async\" src=\"https:\/\/images.theconversation.com\/files\/364006\/original\/file-20201016-21-gs173f.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip\" alt=\"An ECG printout, stethoscope, eyeglasses and medication.\"\/><figcaption class=\"wp-element-caption\">\n              <span class=\"caption\">People with chronic conditions who are not getting regular care during the pandemic are at risk of becoming more seriously ill. <span class=\"source\">(Unsplash)<\/span><\/span><br>\n            <\/figcaption><\/figure>\n\n\n\n<p>Individuals in poorer health, like those with chronic conditions, face a double-edged sword with COVID-19. On one hand, they are more likely to <a href=\"https:\/\/www.mayoclinic.org\/diseases-conditions\/coronavirus\/in-depth\/coronavirus-who-is-at-risk\/art-20483301\" target=\"_blank\" rel=\"noopener noreferrer\">develop severe forms of COVID-19<\/a> if they become infected. This gives them incentive to limit social exposure, including contacts with health-care providers and clinic environments. On the other hand, these individuals are likely to become more seriously ill if their conditions are not <a href=\"https:\/\/bmcfampract.biomedcentral.com\/articles\/10.1186\/s12875-017-0692-3\" target=\"_blank\" rel=\"noopener noreferrer\">properly managed and monitored<\/a>, which requires contacts with the health-care system. <\/p>\n\n\n\n<p>Again, individuals in poorer health report consistently higher unmet health-care needs than their healthier counterparts, which means they are more at risk of insufficient care during the COVID pandemic.<\/p>\n\n\n\n<p>For those two above subgroups, and for others too, having a regular doctor helps ensure individuals get the health care they need. But Canada does not compare well to <a href=\"https:\/\/www.healthaffairs.org\/doi\/10.1377\/hlthaff.2013.0879\" target=\"_blank\" rel=\"noopener noreferrer\">other industrialized countries<\/a> when it comes to timely access to health-care services. <\/p>\n\n\n\n<p>Lack of access to care is often linked to Canada\u2019s high level of unattached patients (those with no regular family physician or other primary care providers). About <a href=\"https:\/\/www150.statcan.gc.ca\/n1\/pub\/82-625-x\/2019001\/article\/00001-eng.htm\" target=\"_blank\" rel=\"noopener noreferrer\">15 per cent of Canadians<\/a> are in this situation. Even worse, in Qu\u00e9bec, the province hardest hit by COVID-19, <a href=\"https:\/\/yourhealthsystem.cihi.ca\/hsp\/inbrief?lang=en#!\/indicators\/074\/has-a-regular-health-care-provider\/;mapC1;mapLevel2;provinceC4000;trend();\/\" target=\"_blank\" rel=\"noopener noreferrer\">close to 22 per cent<\/a> have no regular provider of care.<\/p>\n\n\n\n<h2 id=\"targeted-solutions\" class=\"wp-block-heading\">Targeted solutions<\/h2>\n\n\n\n<p><\/p>\n\n\n\n<p>Targeting these subgroups should be part of the <a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S2211883720300940?via%3Dihub\" target=\"_blank\" rel=\"noopener noreferrer\">policy package<\/a> to address the implications of COVID-19. Ensuring that all Canadians have a regular provider of care shall also <a href=\"https:\/\/liberal.ca\/liberals-move-forward-to-boost-investments-in-health-care-and-make-sure-all-canadians-have-a-family-doctor\/\" target=\"_blank\" rel=\"noopener noreferrer\">stay high on the policy and political agendas<\/a>, even though it is not absolutely necessary for the <a href=\"https:\/\/doi.org\/10.1111\/1475-6773.13059\" target=\"_blank\" rel=\"noopener noreferrer\">primary care provider to be a physician<\/a>. <\/p>\n\n\n\n<p>Efforts to address this issue, like the creation of a <a href=\"https:\/\/www.longwoods.com\/content\/25555\/centralized-waiting-lists-for-unattached-patients-in-primary-care-learning-from-an-intervention-imp\" target=\"_blank\" rel=\"noopener noreferrer\">centralized waiting list<\/a>, have shown mixed effectiveness. During COVID-19, accelerating formal enrolment with a family physician for those on a <a href=\"https:\/\/www.ramq.gouv.qc.ca\/SiteCollectionDocuments\/professionnels\/infolettres\/2020\/info015-20.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">centralized waiting list in Qu\u00e9bec<\/a> goes in the right direction. But this will work only if patients can attend the clinic.<\/p>\n\n\n\n<figure class=\"wp-block-image align-center\"><img decoding=\"async\" src=\"https:\/\/images.theconversation.com\/files\/364004\/original\/file-20201016-23-4jddfs.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip\" alt=\"A woman in casual clothes on a sofa consulting with a doctor on her laptop.\"\/><figcaption class=\"wp-element-caption\">\n              <span class=\"caption\">The use of telemedicine has increased during the pandemic. <span class=\"source\">(Pexels\/Canva)<\/span><\/span><br>\n            <\/figcaption><\/figure>\n\n\n\n<p>The use of telemedicine has jumped during the pandemic, and while this may have helped those with chronic conditions, one issue is that there has been variation across provinces in incorporating telemedicine procedures <a href=\"https:\/\/www.cihi.ca\/en\/physician-billing-codes-in-response-to-covid-19\" target=\"_blank\" rel=\"noopener noreferrer\">in doctors\u2019 billing schedules<\/a>. In Ontario, the other hard hit province, more <a href=\"https:\/\/www.theglobeandmail.com\/canada\/article-doctors-association-says-help-from-government-is-not-enough-to-2\/\" target=\"_blank\" rel=\"noopener noreferrer\">complications around the billings<\/a> may have put some clinics in difficult financial situation and in turn affected access to care. And the telemedicine approach is likely to support women\u2019s better access to care only if it is coupled with after-hours and weekend access, due to their typically higher familial responsibilities.<\/p>\n\n\n\n<h2 id=\"gaps-in-data\" class=\"wp-block-heading\">Gaps in data<\/h2>\n\n\n\n<p><\/p>\n\n\n\n<p>Overall, the effects of delayed care cannot be underestimated. For example, non-urgent procedures and elective surgeries in Ontario have been <a href=\"https:\/\/www.cihi.ca\/en\/covid-19-intervention-timeline-in-canada\" target=\"_blank\" rel=\"noopener noreferrer\">postponed for more than two months<\/a>, with the queue building up as new and postponed patients seek care. <\/p>\n\n\n\n<p>One issue is that in Canada, we do not know exactly how much care has been postponed or foregone. Other countries like <a href=\"https:\/\/www.lemonde.fr\/sciences\/article\/2020\/07\/13\/diagnostics-prise-en-charge-traitements-le-coronavirus-a-des-effets-sanitaires-collateraux-tres-larges_6046098_1650684.html\" target=\"_blank\" rel=\"noopener noreferrer\">France<\/a> and <a href=\"https:\/\/www.commonwealthfund.org\/publications\/2020\/aug\/impact-covid-19-pandemic-outpatient-visits-changing-patterns-care-newest\" target=\"_blank\" rel=\"noopener noreferrer\">the United States<\/a> are able to report this information publicly. <\/p>\n\n\n\n<p>While <a href=\"https:\/\/www.ices.on.ca\/About-ICES\/Collaborations-and-Partnerships\/HDRN-DASH\" target=\"_blank\" rel=\"noopener noreferrer\">progress is made<\/a> on the data front, and more <a href=\"https:\/\/news.ontario.ca\/en\/release\/58314\/ontario-quebec-summit-strengthens-ties-between-the-two-provinces\" target=\"_blank\" rel=\"noopener noreferrer\">co-ordination across provinces<\/a> is on the way, what Canada needs is a better health data infrastructure and reporting system, <a href=\"https:\/\/theconversation.com\/a-national-health-data-infrastructure-could-manage-pandemics-with-less-disruption-140407\" target=\"_blank\" rel=\"noopener noreferrer\">not only for managing the pandemic<\/a>, but also for ensuring everyone\u2019s health-care needs are met.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p><\/p>\n\n\n\n<p>This article is republished from <a href=\"https:\/\/theconversation.com\/institutions\/carleton-university-900\" target=\"_blank\" rel=\"noopener noreferrer\">The Conversation<\/a> under a Creative Commons license. Carleton University is a member of this unique digital journalism platform that launched in June 2017 to boost visibility of Canada\u2019s academic faculty and researchers. Interested in writing a piece? Please contact <a href=\"mailto:steven.reid3@carleton.ca\">Steven Reid<\/a> or <a href=\"https:\/\/theconversation.com\/become-an-author\" target=\"_blank\" rel=\"noopener noreferrer\">sign up to become an author<\/a>.<\/p>\n\n\n\n<p><em>All photos provided by The Conversation from various sources.<\/em><\/p>\n\n\n\n<p>&#8212;<br>\n<a href=\"https:\/\/newsroom.carleton.ca\/\">Carleton Newsroom<\/a><\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/counter.theconversation.com\/content\/145934\/count.gif?distributor=republish-lightbox-basic\" alt=\"The Conversation\"\/><\/figure>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>As the second wave of COVID-19 has now officially hit Central Canada (Qu\u00e9bec and Ontario), we can expect health-care system resources to again be disproportionally demanded by COVID-19 patients. Addressing the direct health implications of the pandemic is clearly necessary, but doing so may come at an indirect cost for non-COVID patients who may struggle [&hellip;]<\/p>\n","protected":false},"author":410,"featured_media":70516,"template":"","meta":{"_acf_changed":false,"footnotes":"","_links_to":"","_links_to_target":""},"cu_story_type":[1623],"cu_story_tag":[],"class_list":["post-70514","cu_story","type-cu_story","status-publish","has-post-thumbnail","hentry","cu_story_type-expert-perspectives"],"acf":{"cu_post_thumbnail":false},"_links":{"self":[{"href":"https:\/\/carleton.ca\/news\/wp-json\/wp\/v2\/cu_story\/70514","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/carleton.ca\/news\/wp-json\/wp\/v2\/cu_story"}],"about":[{"href":"https:\/\/carleton.ca\/news\/wp-json\/wp\/v2\/types\/cu_story"}],"author":[{"embeddable":true,"href":"https:\/\/carleton.ca\/news\/wp-json\/wp\/v2\/users\/410"}],"version-history":[{"count":3,"href":"https:\/\/carleton.ca\/news\/wp-json\/wp\/v2\/cu_story\/70514\/revisions"}],"predecessor-version":[{"id":70520,"href":"https:\/\/carleton.ca\/news\/wp-json\/wp\/v2\/cu_story\/70514\/revisions\/70520"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/carleton.ca\/news\/wp-json\/wp\/v2\/media\/70516"}],"wp:attachment":[{"href":"https:\/\/carleton.ca\/news\/wp-json\/wp\/v2\/media?parent=70514"}],"wp:term":[{"taxonomy":"cu_story_type","embeddable":true,"href":"https:\/\/carleton.ca\/news\/wp-json\/wp\/v2\/cu_story_type?post=70514"},{"taxonomy":"cu_story_tag","embeddable":true,"href":"https:\/\/carleton.ca\/news\/wp-json\/wp\/v2\/cu_story_tag?post=70514"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}