Social inequalities in medical appointment cancellations and reschedulings at the onset of the COVID-19 epidemic in France.

Abstract

Inconsistent results are found regarding social inequalities related to healthcare appointment cancellations during the COVID-19 crisis. Whether rescheduling was associated with social status is unknown. By studying both cancellations and rescheduling, we comprehensively describe which social groups were affected by care disruption. First follow-up of a random population-based cohort was used, including 95 118 people aged 18 or older at baseline and who live in France. Poisson and multinomial regressions were used to study social factors associated with experiencing both medical appointment cancellation by health professionals during the first COVID-19 lockdown, and rescheduling within six months. Among all individuals (including those without scheduled appointment), 21.1% reported cancellations initiated by healthcare professionals. Women, the richest, and those with a chronic disease were the most affected by these cancellations. Although 78.1% who had their appointment cancelled obtained a new appointment within six months, 6.6% failed to reschedule and 15.2% did not want to reschedule. While the oldest were more likely to reschedule, regardless of their health status, the poorest and those with multiple chronic diseases were less likely to do so. Difficulties in rescheduling revealed certain social groups were ultimately more penalized by the restriction of access to care during the first wave of the COVID-19 pandemic. Given that the poorest people, a social group that is in poorer health condition compared to other groups, were the most affected, our results raise questions about the ability of the healthcare system to reduce social health inequalities during a major health crisis.