Patient income level and health insurance correlate with differences in health care utilization during the COVID-19 pandemic

Abstract

Background: With the coronavirus outbreak of 2019 (COVID-19) came many changes in how health care is accessed and delivered. Perhaps most notable is the massive expansion of telemedicine, especially in the developed world. With pandemic-induced economic and health care system disruptions, it is reasonable to expect changes in how health care services are utilized by different patients. We examined how health care service usage trends changed for various patient demographics from the pre-COVID-19 era to the COVID-19 era. Design and methods: De-identified patient demographics and telemedicine, in-patient, in-person out-patient, radiology/procedures, and emergency department visit data ( N = 1,164,719) between January 1st, 2019 and May 31st, 2021 were obtained from UHealth in Miami, Florida, USA. This cross-sectional study employed descriptive statistics and other tools to determine relationships between patient demographics and health system usage. Results: There were significant changes in health care usage and demographics for UHealth services from the pre-COVID-19 era to the COVID-19 era. There was an increase in telehealth visits and a corollary decrease of in-person out-patient visits ( p < 0.001) along with increased health care utilization by those with commercial insurance ( p < 0.001) during COVID-19. Lower-income patients had increased use of in-person out-patient services ( p < 0.001). Non-Hispanic, English-speaking patients and those with higher median incomes had higher telemedicine usage. Conclusions: COVID-19 revealed differences in health care access, particularly telemedicine access, and highlighted differences in vulnerability among patient demographics. These trends are likely multifactorial and reflect changes in patients’ preferences and disparities in care access.

Changes in Outpatient Health Care Use After COVID-19 Infection Among Veterans

“…The COVID-19 pandemic strained health care systems worldwide and altered patient access to care. Systematic reviews of multinational evidence found a nearly universal decline in in-person outpatient health care use in the pandemic’s early stages, but a marked increase in the use of telehealth . Many of these prior health care utilization studies were population-level comparisons of health care use before and during the pandemic rather than comparisons of COVID-19–infected and uninfected cohorts.…”

“…Systematic reviews 1 , 2 , 3 of multinational evidence found a nearly universal decline in in-person outpatient health care use 4 in the pandemic’s early stages, but a marked increase in the use of telehealth. 5 , 6 , 7 , 8 Many of these prior health care utilization studies were population-level comparisons of health care use before and during the pandemic rather than comparisons of COVID-19–infected and uninfected cohorts. This confounds individual-level effects of COVID-19 on health care use with the pandemic’s systemic effects on health care delivery.…”