Long COVID-19 Associated With Reduced Care Access, Higher Costs for Patients

Adults with long COVID-19, or post-COVID-19 condition, faced barriers in accessing and paying for health care, according to a study published in JAMA Network Open. Lead author Michael Karpman, MPP, affiliated with the Urban Institute, sat down with Integrated Healthcare Executive to discuss the implications of the findings.

“There has been limited research on the health care experiences of people with long COVID-19, which is important because people's access to high quality care can make a difference in their wellbeing and ability to work and carry out other daily activities. Getting care can expose people to significant out-of-pocket medical expenses that could make their recovery even more challenging. It's very important to understand differences in health care access and affordability between adults with [and without] long COVID-19,” Mr Karpman said.

The survey study was conducted using the Health Reform Monitoring Survey, which involved a nationally representative sample of 9484 adults in the United States. The participants were aged between 18 and 64 years. 

Mr Karpman and co-investigators identified individuals with self-reported post-COVID-19 condition, defined as patients experiencing symptoms that could not be attributed to other factors for more than 4 weeks following COVID-19 infection. 

“We also asked people about various experiences with health care, including whether they had unmet needs for care because of costs, difficulty finding providers or using health insurance, as well as problems paying medical bills and past due medical debt. We estimated the association of long COVID-19 with these access and affordability challenges, controlling for differences in the demographic and health characteristics between adults with long COVID-19, those with a COVID-19 diagnosis but not long COVID-19, and those who had never been diagnosed with COVID-19 at all,” Mr Karpman said.

Out of 9599 respondents, 3382 people reported ever being diagnosed with COVID-19 (36.4%; 95% CI, 34.7%-38.2%), and 833 people reported having post-COVID-19 condition (22.5%; 95% CI, 20.9%-24.2%).

“We found that adults with long COVID-19 were more likely than others to be women, Hispanic, or have other chronic physical health conditions, which is consistent with previous research. Even though most adults with long COVID-19 had been insured all year and had a usual source of care, they were much more likely than other groups to report foregoing care because of cost,” Mr Karpman said.

People with post-COVID-19 condition were more likely than those without to experience unmet needs related to: 

• costs (27.0%; 95% CI, 23.2%-30.7% vs 18.3%; 95% CI, 15.9%-20.7% and 17.5%; 95% CI, 15.4%-19.6%);
• difficulty finding providers accepting new patients (16.4%; 95% CI, 14.3%-18.4% vs 10.1%; 95% CI, 8.8%-11.5% and 10.7%; 95% CI, 9.6%-11.8%);
• getting a timely appointment (22.0%; 95% CI, 19.3%-24.8% vs 14.4%; 95% CI, 13.2%-15.7% and 13.9%; 95% CI, 12.9%-14.8%); 
• and getting health plan care authorization (16.6%; 95% CI, 14.6%-18.6% vs 10.8%; 95% CI, 9.6%-12.1% and 10.3%; 95% CI, 9.4%-11.2%) (P < .001 for all comparisons).

“As long COVID-19 is an emerging condition, there's a need to accelerate research on potential treatments, disseminate clinical guidelines, and provide training to health care providers. The study findings also highlight the barriers that people face with health insurance and out-of-pocket health care costs,” Mr Karpman said.

Mr Karpman suggested further research into the nature of insurance-related barriers, including definitions of medically necessary care, variations in these definitions between insurers, and administrative burdens that may cause claims denials such as prior authorization.

“In general, there’s a need for greater transparency and standards on how insurers are covering treatment for long COVID-19,” Mr Karpman said, adding that there is a need for “further research on patients' experiences getting care for long COVID-19, the persistence of these access challenges over time, and the consequences of these health care access barriers for people’s wellbeing.”

About Mr Karpman

Michael Karpman, MPP, is a principal research associate at the Urban Institute's Health Policy Center in Washington, DC.