Financial burden of patients with post-acute COVID-19 syndrome, 2025, Scheel-Barteit et al

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Financial burden of patients with post-acute COVID-19 syndrome

Jennifer Scheel-Barteit, Caroline Floto, Henrike Höpfner, Thomas Kühlein, Bettina Hohberger, Maria Sebastião

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Aim
The present study aimed to analyze the financial burden of German patients with Post‐acute COVID‐19 syndrome (PCS) and its predictors exploratively. Information regarding the financial burden of PCS patients and its predictors is of vital importance to identify patients at high risk and address the support needed by this patient group.

Subject and methods
As no established diagnostic process or therapy exists, many PCS patients are dissatisfied with standard health care and engage in out-of-pocket payments (OOPPs) for diagnostics and therapy. This is particularly problematic as they often experience a simultaneous change of employment status and loss of income. In the present cross-sectional study, data on financial burden (changes in employment status, loss of income, OOPPs) were assessed via a self-report online questionnaire.

Results
PCS is a high subjective financial burden for 91.0% of the participants. About 80% of the PCS patients reported high financial losses due to loss of income and high costs due to OOPPs. A wide spectrum of conventional and complementary / alternative diagnostic and therapeutic procedures was reported.

The most frequent type of OOPP diagnostics were vitamin level tests (56.2%), antibody detection (43.8%), and trace element level tests (42.4%). The most frequent type of OOPP therapies were dietary supplements (67.1%), osteopathy (30.1%), physiotherapy / physical therapy (28.2%), relaxation techniques (24.2%), and acupuncture (20.7%).

In regression analyses, change of employment status was predicted by income, type of health care insurance, subjective impairments in day-to-day-life, physician contacts, Post-COVID-Clinic, and contact with a support group. High loss of income was predicted by sex, higher education, change of employment status, income, type of health care insurance, subjective impairments in day-to-day-life, and physician contacts.

High OOPPs were predicted by education, health status pre PCS, subjective impairments in day-to-day-life, physician contacts, contact to alternative / complementary practitioners, and contact to a support group.

Conclusions
PCS patients in Germany suffer from a high financial double burden of loss of income and additional costs due to OOPP diagnostics and therapies. Until effective PCS therapies are implemented in standard care, patients should receive medical information and counseling. Also, the public should be informed regarding non-effective PCS therapies.

Web | PDF | Journal of Public Health | Open Access
 
These problems have several (political) implications:

(1) Medical support and information strategies regarding the PCS patients at particularly high risk of being victim of useless medical services should be improved.

(2) The public should be informed of non-effective PCS therapies.

(3) Therapies for PCS should be further evaluated. Until effective ones are implemented in standard care, patients should receive medical information and counseling from their general practitioner (that there is no effective therapy at present, that their general practitioner supports them with their symptoms, that therapy research is done, that the long-term prognosis is not hopeless (natural course/remission), and that they should be cautious regarding the promises of expensive OOPP therapies).

(4) Care pathways should be optimized (in case of no effective therapy, this means particularly no unnecessary referrals to other specialists beside Post-COVID-Clinics).

(5) Strategies to enable PCS patients to return to work should be implemented, e.g. structural changes like modifications of working hours, working task, and working place/telework (Straßburger et al. 2023; Cutler 2022).
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Other than the Post-COVID clinics that themselves are unproven, this seems like a reasonable take.

The even better option would be to create specialist centres that can follow patients long term and aid research.

It’s also a shame that they seemingly gloss over how the default today is the BPS approach. It isn’t just the patients that need education about avoiding ineffective treatments!
 
The paper said:
PCS is a high subjective financial burden for 91.0% of the participants. About 80% of the PCS patients reported high financial losses due to loss of income and high costs due to OOPPs.
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A very odd use of subjective, as loss of income and added costs are some of the most objective measures out there. I guess by that they must want to mean that the attribution is subjective, but won't say it loud because 1) they don't have to, and 2) it has no evidence.
PCS patients in Germany suffer from a high financial double burden of loss of income and additional costs due to OOPP diagnostics and therapies. Until effective PCS therapies are implemented in standard care, patients should receive medical information and counseling.
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What does that have to do with anything? How would counseling or "medical information" matter here? I don't even understand what they're trying to argue, it doesn't make sense of reality at all. They don't even understand the problem, none of their training applies here, they know less than the average patient does, so what could they even inform of us? When they don't even have that information themselves?

As is tradition, they love to whine about alternative medicine being something people fall back onto, but offer their own nonsense in response, which is a main reason why there is still nothing useful, and now people face the double bind of having to choose between: nothing, unofficial pseudoscience, or official pseudoscience.

The annoying thing is that nothing builds on itself. Everything is still stuck at the first stage, nothing moves until they get biomedical benediction. Nothing happens on the way to it, and it only happens in a single step: someone stumbles on the answer. The systems of medicine are almost completely unfit for purpose here, it's staggering to see how it's met not only with indifference, but with fanatical insistence to stick with what has never worked.

It's also amazing how it's so common to note how there aren't any treatments, a widely known fact, while so many claim that there are, in fact, such treatments: rehabilitation. Which no evidence to support it. And they call this evidence-based medicine.
Utsikt said:
They have hard numbers in table 4 about the reported monthly income loss, so I have no idea why they didn’t include that in the abstract. Seems like they paid most attention to the alternative treatments.
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They wanted to argue something else. Although it's definitely true that loss of income becomes subjective after a while. How much money am I losing this year, not knowing anything about how my life would be if I had been healthy all this time? Impossible to tell. Could be $50K. Could be $1M. Or anywhere in-between.

But they are doing it in the only context in which they can catch this: early, and quantifiably. And still they fail at it, because here they only wanted to argue "alternative medicine bad", which is accurate, while glossing completely over the fact that bad alternative medicine is all that the medical profession has produced for us.
 
rvallee said:
A very odd use of subjective, as loss of income and added costs are some of the most objective measures out there. I guess by that they must want to mean that the attribution is subjective, but won't say it loud because 1) they don't have to, and 2) it has no evidence.

What does that have to do with anything? How would counseling or "medical information" matter here? I don't even understand what they're trying to argue, it doesn't make sense of reality at all. They don't even understand the problem, none of their training applies here, they know less than the average patient does, so what could they even inform of us? When they don't even have that information themselves?

As is tradition, they love to whine about alternative medicine being something people fall back onto, but offer their own nonsense in response, which is a main reason why there is still nothing useful, and now people face the double bind of having to choose between: nothing, unofficial pseudoscience, or official pseudoscience.

The annoying thing is that nothing builds on itself. Everything is still stuck at the first stage, nothing moves until they get biomedical benediction. Nothing happens on the way to it, and it only happens in a single step: someone stumbles on the answer. The systems of medicine are almost completely unfit for purpose here, it's staggering to see how it's met not only with indifference, but with fanatical insistence to stick with what has never worked.

It's also amazing how it's so common to note how there aren't any treatments, a widely known fact, while so many claim that there are, in fact, such treatments: rehabilitation. Which no evidence to support it. And they call this evidence-based medicine.

They wanted to argue something else. Although it's definitely true that loss of income becomes subjective after a while. How much money am I losing this year, not knowing anything about how my life would be if I had been healthy all this time? Impossible to tell. Could be $50K. Could be $1M. Or anywhere in-between.

But they are doing it in the only context in which they can catch this: early, and quantifiably. And still they fail at it, because here they only wanted to argue "alternative medicine bad", which is accurate, while glossing completely over the fact that bad alternative medicine is all that the medical profession has produced for us.
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Yes, if they are reporting an amount then surely it is 'income' or 'decrease'

I don't think it is accurate either as a term for what they collected?! Unless it is literally a fault due to inaccurate translation from one language to another, which is still then by definition inaccurate?

I looked up the definition for 'subjective income' and got this from AI:

Subjective income refers to an individual's personal assessment of their economic well-being, focusing on their perception of their income's adequacy to meet their needs and goals, rather than just the numerical value of their income. It's a measure of how satisfied someone is with their financial situation, considering their expenses, debts, and ability to achieve their desired lifestyle.
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  • Contrast with objective income:
    While objective income is a specific monetary amount, subjective income is a personal evaluation of that amount's adequacy.
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