PAIS treatment disparities and medication-cost strain in Austria, Germany and Switzerland

Background

Post-acute infection syndromes (PAIS) are characterized by prolonged symptoms after acute infection, often lasting years and substantially impairing quality of life. Affected individuals often face barriers to healthcare access, and associated out-of-pocket costs can impose substantial financial burden. While private health insurance may offer broader coverage, it can also exacerbate inequalities in access and financial protection. Given the limited evidence for PAIS in this regard, this study examines treatment disparities by (private) health insurance status in Austria (AT), Germany (DE), and Switzerland (CH).

Methods

We conducted an online cross-sectional survey among individuals with PAIS (11/2024-02/2025), assessing symptoms, (non-drug) treatments and self-perceived financial strain from medication costs. The survey was distributed via social media and patient organisations. We compared treatment use and perceived financial strain by insurance status and conducted logistic regression analyses to identify associated factors, adjusting for age and sex.

Results

In total, 1,634 participants participated (AT: 36%, DE: 56%, CH: 8%) and private health insurance ranged from 14% (DE) to 36% (CH). Privately insured participants reported more medications (median 3 vs. 2) and non-drug treatments (median 8 vs. 7). Financial strain was reported by 48% without private insurance and 40% with private insurance. In the regression analysis, respondents in Switzerland, and those with higher education and income, experienced lower financial strain.

Conclusions

Private health insurance is linked to differences in treatment use. Yet, financial strain persisted even among the privately insured individuals with PAIS. This appeared to be driven more by country-specific health system characteristics and socioeconomic factors than by insurance status alone, highlighting systemic gaps in coverage and affordability across the healthcare systems.

Key messages

• Privately insured individuals with PAIS reported slightly higher treatment utilisation, but still experience financial strain due to treatment costs.

• Financial strain from PAIS medication is shaped more by country context and socioeconomic status than by insurance status, pointing to gaps in affordability and access.