IMPORTANCE The coronavirus disease 2019 (COVID-19) pandemic has placed unprecedented strain on patients and health care professionals and institutions, but the association of the pandemic with use of preventive, elective, and nonelective care, as well as potential disparities in use of health care, remain unknown. OBJECTIVE To examine changes in health care use during the first 2 months of the COVID-19 pandemic in March and April of 2020 relative to March and April of 2019 and 2018, and to examine whether changes in use differ by patient's zip code-level race/ethnicity or income. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study analyzed health insurance claims for patients from all 50 US states who receive health insurance through their employers. Changes in use of preventive services, nonelective care, elective procedures, prescription drugs, in-person office visits, and telemedicine visits were examined during the first 2 months of the COVID-19 pandemic in 2020 relative to existing trends in 2019 and 2018. Disparities in the association of the pandemic with health care use based on patient's zip code-level race and income were also examined.

Introduction The coronavirus disease 2019 (COVID-19) pandemic has forced telehealth to be the primary mechanism for patients to interact with their providers. There is a concern that the pandemic will exacerbate existing disparities in overall healthcare utilization and telehealth utilization. Few national studies have examined changes in telehealth use during the COVID-19 pandemic. Methods Data on 6.8 and 6.4 million employer-based health plan beneficiaries in 2020 and 2019 were collected in 2020. Unadjusted rates were compared both before and after the week of the declaration of COVID-19 pandemic as a national emergency. Trends in weekly utilization were also examined using a difference-in-differences regression framework to quantify changes in telemedicine and office-based care utilization while controlling for the patient's demographic and county-level sociodemographic measures. All analyses were conducted in 2020. Results More than a 20-fold increase in the incidence of telemedicine utilization following March 13, 2020 was observed. Conversely, the incidence of office-based encounters declined almost 50% and was not fully offset by the increase in telemedicine. The increase in telemedicine was greatest among patients in counties with low poverty levels (β=31.70, 95% CI=15.17, 48.23), among patients in metropolitan areas (β=40.60, 95% CI=30.86, 50.34), and among adults compared with children aged 0–12 years (β=57.91, 95% CI=50.32, 65.49). Conclusions The COVID-19 pandemic has affected telehealth utilization disproportionately based on patient age, and both county-level poverty rate and urbanicity.

BACKGROUND Breast and colorectal cancer are two of the most commonly diagnosed cancers in the USA, generating 400,000 new cases and 90,000 attributable deaths in 2019 alone. Early detection through routine screenings is essential for improving cancerrelated morbidity and mortality rates. 1 The COVID-19 pandemic has created the potential for a backslide in cancer screening rates, particularly forms of screening like mammography and colonoscopy that rely on office-based medical technologies. 2 Yet, whether cancer screening rates have declined, and how reductions vary across patient populations, remains largely unknown. OBJECTIVE To examine mammography and colonoscopy rates among commercially insured American adults before and after March 13, 2020-the date on which COVID-19 was declared a national emergency-as well as US county-level characteristics predictive of screening rates. METHODS We quantified weekly medical claims from commercially insured US adults between January 15, 2020, and July 31, 2020. Medical claims data were provided by Castlight Health, a health benefits manager for employer-sponsored health insurance plans across all 50 states, which included 6.8 million individuals. 3 We limited the study sample to those ages 46 to 64, target populations for cancer screening procedures prior to Medicare eligibility. For screening mammography, we limited our sample to women. Procedures were identified using IBM Watson Health procedure categories. 4 We calculated weekly number of individuals, per 10,000 eligible beneficiaries, who received cancer screenings. We also included patient age category (ages 46-59, 60-64) and sex, and linked claims to

The COVID-19 pandemic has forced federal, state, and local policymakers to respond by legislating, enacting, and enforcing social distancing policies. However, the impact of these policies on healthcare utilization in the United States has been largely unexplored. We examine the impact of county-level shelter in place ordinances on healthcare utilization using two unique datasets—employer-sponsored insurance for over 6 million people in the US and cell phone location data. We find that introduction of these policies was associated with reductions in the use of preventive care, elective care, and the number of weekly visits to physician offices, hospitals and other health care-related industries. However, controlling for county-level exposure to the COVID-19 pandemic as a way to account for the endogenous nature of policy implementation reduces the impact of these policies. Our results imply that while social distancing policies do lead to reductions in healthcare utilization, much of these reductions would have occurred even in the absence of these policies.

The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research. NBER working papers are circulated for discussion and comment purposes. They have not been peer-reviewed or been subject to the review by the NBER Board of Directors that accompanies official NBER publications.