Non-COVID-19 health care visits declined dramatically as pandemic hit

Study shows state closure policies were associated with large declines in outpatient visits

BLOOMINGTON, Ind. -- Since early March, the U.S. health care system has been focused on providing life-saving care for COVID-19 patients. States closed non-essential activities, and people curtailed interactions outside their homes to slow the spread of the COVID-19 virus.

But a new study co-authored by Indiana University researchers indicates that use of non-COVID-19 care declined during this time period as people either deferred or skipped care, which may have important implications for their current and future health.

Kosali SimonView print quality image
Kosali Simon.   Photo by Chris Meyer, Indiana University

"A combination of private responses and public policies related to the epidemic likely affected the way people use the health care system for conditions unrelated to COVID-19," said Kosali Simon, the Herman B Wells professor in the O'Neill School of Public and Environmental Affairs at IU Bloomington and one of study's co-authors. "This is the first look at how different state policies affected non-COVID-19 outpatient health care, as a way to understand what actions might be needed to protect all of health care as we continue living through the pandemic."

The study's other authors are Engy Ziedan, an assistant professor of economics at Tulane University, and Coady Wing, an associate professor in the O'Neill School.

The researchers examined data from a nationwide electronic health care records system covering more than 35 million patients and providing information on health care use from January 2019 through June 30, 2020. They focused on outpatient visits, outpatient procedures and laboratory tests for non-COVID-19 care.

They found that overall, health care visits declined about 40 percent during the first six weeks or so of the pandemic, from early March to mid-April. State policies ordering people to stay at home and closing non-essential businesses played a substantial role, reducing outpatient visits by about 15 percent in the first two weeks of the shutdown.

The negative impact varied by type of care, however, according to the study. Visits associated with heart disease declined dramatically, as did outpatient visits for diabetes and various cancers. But mental health outpatient visits declined far less than the other care categories studied. The researchers concluded that telemedicine delivering mental health services may have mitigated the decline in mental health care visits.

While outpatient visits rebounded substantially in recent months following re-openings, the researchers noted that care visits still remain below the pre-epidemic levels in most cases.

"Our work sheds light not only on the overall decline and recovery of health care utilization, but also on the ways that the epidemic has disrupted some types of services and therapies more than others," the researchers wrote. "Understanding these patterns is important to prepare the health care system to address health consequences in the future that will be caused by the shortfalls in health care use during this era."

The paper, "Effects of State COVID-19 Closure Policy on Non-COVID-19 Health Care Utilization" was published online as a working paper by the National Bureau of Economic Research.

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