Impact of the COVID-19 Pandemic on the Pediatric Hospital Visits: Evidence from the State of Florida

Abstract

Although early evidence reported a substantial decline in pediatric hospital visits during COVID-19, it is unclear whether the decline varied across different counties, particularly in designated Medically Underserved Areas (MUA). The objective of this study is to explore the state-wide impact of COVID-19 on pediatric hospital visit patterns, including the economic burden and MUA communities. We conducted a retrospective observational study of pediatric hospital visits using the Florida State all-payer Emergency Department (ED) and Inpatient dataset during the pandemic (April–September 2020) and the same period in 2019. Pediatric Treat-and-Release ED and inpatient visit rates were compared by patient demographics, socioeconomic, diagnosis, MUA status, and hospital characteristics. Pediatric hospital visits in Florida decreased by 53.7% (62.3% in April–June, 44.2% in July–September) during the pandemic. The Treat-and-Release ED and inpatient visits varied up to 5- and 3-fold, respectively, across counties. However, changes in hospital visits across MUA counties were similar compared with non-MUA counties except for lower Treat-and-Release ED volume in April–May. The disproportional decrease in visits was notable for the underserved population, including Hispanic and African American children; Medicaid coverages; non-children’s hospitals; and diagnosed with respiratory diseases, appendicitis, and sickle-cell. Florida Hospitals experienced a USD 1.37 billion (average USD 8.3 million) decline in charges across the study period in 2020. Disproportionate decrease in hospital visits, particularly in the underserved population, suggest a combined effect of the persistent challenge of care access and changes in healthcare-seeking behavior during the pandemic. These findings suggest that providers and policymakers should emphasize alternative interventions/programs ensuring adequate care during the pandemic, particularly for high-risk children.

The impact of COVID‐19 on adolescents with eating disorders: Increased need for medical stabilization and decreased access to care

“…Our results showed a significant decline in patients with Medicaid and a significant increase in patients with private insurance presenting for medical stabilization during the pandemic. While research has demonstrated a decline in hospital admissions during the early phase of the pandemic across payer groups, there was a disproportionate decline in healthcare utilization for pediatric patients with Medicaid (Symum et al, 2022). COVID‐19 likely caused additional financial strain and transportation barriers on patients with Medicaid, which negatively impacted attendance at doctor's appointments or Emergency Department visits.…”

Ingestion of Illicit Substances by Young Children Before and During the COVID-19 Pandemic

“…The outcome encounter rate is defined as the number of ingestions per month per 10 000 all-cause hospital encounters calculated using the rolling 12-month mean for all-cause hospital encounters to account for seasonal fluctuations in number of encounters. Because hospital encounters substantially decreased during the first several months of the pandemic, which would falsely elevate the illicit substance ingestion rate, the total encounters for 2019 were used for the denominator for rates in 2020 and 2021 …”

“…Because hospital encounters substantially decreased during the first several months of the pandemic, which would falsely elevate the illicit substance ingestion rate, the total encounters for 2019 were used for the denominator for rates in 2020 and 2021. 15 , 16 , 17 , 18 , 19 …”

“…Because hospital encounters substantially decreased during the first several months of the pandemic, which would falsely elevate the illicit substance ingestion rate, the total encounters for 2019 were used for the denominator for rates in 2020 and 2021. [15][16][17][18][19] The primary variables were time in months and the absence or presence of the pandemic with the pandemic period starting on April 1, 2020. Ingestion encounters from March 2020 were excluded from analyses as shelter-in-place orders, physical distancing restrictions, and daycare and school closures were implemented at different times across PHIS hospital catchment areas from March 10, 2020, to March 31, 2020.…”