Key messages

• COVID-19 meant non-emergency procedures were postponed which led to backlogs of care (and particularly hospital and specialist care) in virtually all countries. These jeopardize health outcomes.
• Countries still struggle to understand the extent of backlogs but they are testing policies in practice and are generating lessons on what works.
• Drivers that increase the backlog include:

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  Supply-side factors, such as: low numbers of health workers (even pre-COVID); lower productivity due to staff exhaustion; the extra cost of providing treatment safely; and weakened incentives for some care.

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  Demand-side factors include: new technologies; the ageing of the population and the rise of chronic conditions (including long COVID).

• Drivers that decrease the backlog include:

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  Supply-side factors, such as: sufficient workforce and infrastructure; extra funding; and more efficient new technologies and digital solutions.

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  On the demand side, fear of infection may reduce demand, although this may also increase unmet need.

• Restoring care to previous levels is not enough to overcome the backlogs but three broad groups of (overlapping) strategies are helping:

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  Increasing workforce and staffing with new professional roles and competencies; flexible recruitment and training; and improved work conditions and compensation.

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  Improving productivity, management of capacity and demand, separating planned and unplanned care; introducing tailored financial incentives; expanding access to telehealth; careful prioritization; and spreading patients to fit available capacity.

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  Investing in capital, infrastructure and new models of care, for example, by upgrading health facilities or digital infrastructure; investing in primary and community care; or expanding home care.

• Policy-makers can reduce the risks associated with these strategies by:

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  Pairing improvements in workforce planning and availability with policies to support and protect health workers.

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  Monitoring policies to rationalize health care delivery, reduce waste or use digital solutions to ensure they do not (inadvertently) increase inequalities in utilization and health.

Contents

• Acknowledgements
• Acronyms
• Foreword
• Executive summary
• POLICY BRIEF
  • 1. Introduction
  • 2. What do we know about the degree of service disruption and size of the backlogs?
  • 3. What are the drivers of waiting times, waiting lists and backlog during and following the COVID-19 pandemic?
  • 4. Which policies are countries using to tackle their backlogs?
  • Conclusions
• References
• The Policy Brief Series

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What is a Policy Brief?