# Theoretically Universal, Practically Unequal: Socio‐Economic Inequalities in Healthcare Access for Long Covid‐19 Patients in Austria

## TL;DR

This study finds that socio-economic factors affect healthcare access for long Covid-19 patients in Austria, despite a universal healthcare system.

## Contribution

The study provides quantitative evidence of income-related inequalities in healthcare access for long Covid-19 patients, particularly in general practitioner care.

## Key findings

- Patients in urban areas, with private insurance, or good economic status reported fewer healthcare barriers.
- Low-income individuals faced more barriers in GP care, including being dismissed or facing high costs.
- Rural residents and those with poor economic situations had higher unmet healthcare needs for specialist and hospital care.

## Abstract

Long Covid‐19 (LC) patients have substantial treatment and care needs, yet research has shown that the majority of them experience healthcare access barriers. While qualitative studies indicate socio‐economic and demographic access inequalities among LC patients, quantitative evidence remains limited. This study aims to assess socio‐economic inequalities in healthcare access among LC patients in Austria, focusing on self‐perceived barriers, facilitators and unmet healthcare needs.

Retrospective cross‐sectional data were collected from adult LC patients through online and paper‐based surveys (10‐12/2024), following a prior qualitative study. The survey assessed 47 barriers and 10 facilitators based on Levesque's ‘access to care’ framework, along with unmet healthcare needs overall and related to general practitioner (GP), specialist and hospital care. Overall barrier and facilitator scores were calculated. Inequalities related to gender, age, urbanicity, health‐related background through training/employment, complementary private health insurance, and economic situation were examined in linear, logistic and ordered logistic regressions, controlling for clinical and demographic variables.

Overall, 433 LC patients completed the survey. Participants living in urban areas, with complementary private health insurance, or in a good economic situation reported fewer barriers, reflected in statistically significantly lower overall barrier scores. Income‐related inequalities emerged particularly in relation to barriers in GP care, including not being taken seriously, attribution of symptoms to mental health conditions, burdensome costs, short consultation times, and limited availability of telemedicine or home visits. Facilitator scores, in contrast, did not differ by socio‐economic factors. Living in a rural area was associated with a higher probability of unmet healthcare needs related to GP and specialist care. A poor economic situation was associated with a higher probability of reporting unmet needs related to specialist and hospital care. No evidence of gender‐based inequalities was found.

Our findings reveal enhanced inequalities in LC healthcare access in an otherwise universal healthcare system. Contrary to prior research, we find income‐related inequalities in GP access. Future policy efforts in Austria should consider that central case management through GP care may not be the most optimal set‐up, especially without improved information, training, support and specialist referral opportunities.

The design of the survey and the hypotheses on healthcare access barriers and facilitators were directly informed by qualitative interviews from previous work with long Covid‐19 (LC) patients, who shared their lived experiences with diagnosis, treatment and navigating the healthcare system. Additionally, LC patients piloted the survey before its launch and provided feedback. Representatives of patient LC groups and individual patients contributed to participant recruitment by sharing study materials within their networks.