Impacts of the COVID-19 Pandemic on Public Hospitals of Different Levels: Six-Month Evidence from Shanghai, China

Abstract

Purpose: Hospitals suffered from a precipitous loss of medical service globally due to COVID-19. The tragedy paradoxically produced an opportunity to investigate the patterns of change in medical services and revenue in hospitals at different levels when faced with a natural shock. This study aims to examine the effects of the COVID-19 pandemic in the first half of 2020 on hospital operation in Shanghai. Methods: We obtained monthly characteristic and operational data of public hospitals (N=156) from January 1, 2018, to July 31, 2020, in Shanghai from the China Statistical Survey of Health Resources and Services Program. We constructed a set of difference-indifferences models to investigate the pandemic (from February 1 to March 31, 2020) and post-pandemic (from April 1 to July 31, 2020) effects on operational outcomes in hospitals of different levels, including outpatient and inpatient visits, outpatient and inpatient revenue, as well as the differential effects on local and nonlocal patients. Results: There were 46 tertiary hospitals and 110 non-tertiary hospitals involved in this study. Compared to a non-tertiary hospital during the COVID-19 pandemic, a tertiary hospital averagely experienced substantially more significant losses in outpatient visits (57.91 thousand, p < 0.01), inpatient visits (1.93 thousand, p < 0.01), outpatient revenue (18.88 million RMB, p < 0.01), and inpatient revenue (30.65 million RMB, p < 0.01) monthly. Compared to a non-tertiary hospital in the post-pandemic period, a tertiary hospital averagely lost more outpatient visits (18.02 thousand, p < 0.01) from all patients and inpatient visits (0.15 thousand, p < 0.01) from nonlocal patients, but was associated with higher inpatient revenue (2.24 million RMB, p < 0.01) from all patients and outpatient revenue (0.87 million RMB, p < 0.01) from nonlocal patients monthly. Conclusion: Medical service and revenue for public hospitals in Shanghai dropped precipitously during the COVID-19 pandemic, but mainly recovered after the pandemic. Compared to non-tertiary hospitals, medical services and revenue in tertiary hospitals experienced more substantial reduction during the pandemic but had a faster recovery that maintained longer during the post-pandemic period.

How has the COVID-19 pandemic affected the utilisation of online consultation and face-to-face medical treatment? An interrupted time-series study in Beijing, China

“…These changes include large reductions in hospital visits, and some selective increases in online health services. [8][9][10] However, minimal data are available on the relationship between hospital visits and online health services over the same period, especially with quantitative time-trend evidence. Examining the short-term and longterm patterns of changes in hospital volume and online health services during the COVID-19 pandemic is valuable.…”

“…As the COVID-19 pandemic continues, many studies have reported major changes in the utilisation of healthcare services because of measures such as lockdowns and stay-at-home orders. These changes include large reductions in hospital visits, and some selective increases in online health services 8–10. However, minimal data are available on the relationship between hospital visits and online health services over the same period, especially with quantitative time-trend evidence.…”

Changes in inpatient admissions before and during COVID-19 outbreak in a large tertiary hospital in Shanghai

“…In China, the utilization of inpatient and outpatient health services in medical institutions of all levels also dropped significantly after the outbreak (2). Among paediatric patients, the number of respiratory tract infections decreased in all facilities in Hunan Province, China (10), while the loss of outpatient visits in tertiary hospitals in Shanghai was greater compared to that in non-tertiary hospitals (11). In primary care settings, the decreased number of visits was related to the reappointment rate and average waiting time (12).…”

Pediatric Residency Training amid the COVID-19 Pandemic: Exploring the Impact of Supervision and Clinical Practice Guidelines on Clinical and Financial Outcomes

“…CPG availability is also highly dependent on the speed of adjustment to changes in the profile of patient visits to the hospital [4,5] because the need for types of CPG can change in a disaster or pandemic condition [3,9]. Changes in the profile of hospital visits are due to restrictions on admitting patients for nonemergency cases, fear of patients being infected in hospitals, and restrictions on social interaction by the government [10][11][12][13][14][15][16][17][18].…”