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Showing content from https://pubmed.ncbi.nlm.nih.gov/33151319/ below:

Changes in Health Services Use Among Commercially Insured US Populations During the COVID-19 Pandemic

. 2020 Nov 2;3(11):e2024984. doi: 10.1001/jamanetworkopen.2020.24984. Changes in Health Services Use Among Commercially Insured US Populations During the COVID-19 Pandemic

Affiliations

¹ RAND Corporation, Santa Monica, California.
² Castlight Health, San Francisco, California.
³ Sol Price School of Public Policy and Schaeffer Center, University of Southern California, Los Angeles.
⁴ National Bureau for Economic Research, Cambridge, Massachusetts.
⁵ Center for Primary Care and Outcomes Research, Stanford, California.

PMID: 33151319
PMCID: PMC7645698
DOI: 10.1001/jamanetworkopen.2020.24984

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Changes in Health Services Use Among Commercially Insured US Populations During the COVID-19 Pandemic

Christopher M Whaley et al. JAMA Netw Open. 2020.

. 2020 Nov 2;3(11):e2024984. doi: 10.1001/jamanetworkopen.2020.24984. Affiliations

¹ RAND Corporation, Santa Monica, California.
² Castlight Health, San Francisco, California.
³ Sol Price School of Public Policy and Schaeffer Center, University of Southern California, Los Angeles.
⁴ National Bureau for Economic Research, Cambridge, Massachusetts.
⁵ Center for Primary Care and Outcomes Research, Stanford, California.

PMID: 33151319
PMCID: PMC7645698
DOI: 10.1001/jamanetworkopen.2020.24984

Item in Clipboard

Abstract

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.

Results: Data from 5.6, 6.4, and 6.8 million US individuals with employer-sponsored insurance in 2018, 2019, and 2020, respectively, were analyzed. Patient demographics were similar in all 3 years (mean [SD] age, 34.3 [18.6] years in 2018, 34.3 [18.5] years in 2019, and 34.5 [18.5] years in 2020); 50.0% women in 2018, 49.5% women in 2019, and 49.5% women in 2020). In March and April 2020, regression-adjusted use rate per 10 000 persons changed by -28.2 (95% CI, -30.5 to -25.9) and -64.5 (95% CI, -66.8 to -62.2) for colonoscopies; -149.1 (95% CI, -162.0 to -16.2) and -342.1 (95% CI, -355.0 to -329.2) for mammograms; -60.0 (95% CI, -63.3 to -54.7) and -118.1 (95% CI, -112.4 to -113.9) for hemoglobin A1c tests; -300.5 (95% CI, -346.5 to -254.5) and -369.0 (95% CI, -414.7 to -323.4) for child vaccines; -4.6 (95% CI, -5.3 to -3.9) and -10.9 (95% CI, -11.6 to -10.2) for musculoskeletal surgery; -1.1 (95% CI, -1.4 to -0.7) and -3.4 (95% CI, -3.8 to -3.0) for cataract surgery; -13.4 (95% CI, -14.6 to -12.2) and -31.4 (95% CI, -32.6 to -30.2) for magnetic resonance imaging; and -581.1 (95% CI, -612.9 to -549.3) and -1465 (95% CI, -1496 to -1433) for in-person office visits. Use of telemedicine services increased by 227.9 (95% CI, 221.7 to 234.1) per 10 000 persons and 641.6 (95% CI, 635.5 to 647.8) per 10 000 persons. Patients living in zip codes with lower-income or majority racial/ethnic minority populations experienced smaller reductions in in-person visits (≥80% racial/ethnic minority zip code: 200.0 per 10 000 [95% CI, 128.9-270.1]; 79%-21% racial/ethnic minority zip code: 54.2 per 10 000 [95% CI, 33.6-74.9]) but also had lower rates of adoption of telemedicine (≥80% racial/ethnic minority zip code: -71.6 per 10 000 [95% CI, -87.6 to -55.5]; 79%-21% racial/ethnic minority zip code: -15.1 per 10 000 [95% CI, -19.8 to -10.4]).

Conclusions and relevance: In this cross-sectional study of a large US population with employer-sponsored insurance, the first 2 months of the COVID-19 pandemic were associated with dramatic reductions in the use of preventive and elective care. Use of telemedicine increased rapidly but not enough to account for reductions in in-person primary care visits. Race and income disparities at the zip code level exist in use of telemedicine.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Whaley reported receiving grants from the National Institutes on Aging and the National Cancer Institute during the conduct of the study. Dr Pera reported receiving personal fees from Castlight Health during the conduct of the study and personal fees from Castlight Health outside the submitted work. Dr Hagg reported receiving personal fees from Castlight Health during the conduct of the study and personal fees from Castlight Health outside the submitted work. Dr Sood reported receiving funding from the Jedel Foundation, University of Southern California (USC) Schwarzenegger Institute, USC Lusk Center, USC President’s Office, and individual donors in support of coronavirus disease 2019–related research (not tied to a particular project); serving as a scientific advisor to Payssurance and Virta Health; serving as an expert witness for the American Medical Association and Goldman, Ismail, Tomaselli, Brennan, and Baum; serving as an international expert for the China Development Research Foundation and the Pharmaceutical Research and Manufacturers of America; and receiving grants from the Agency for Healthcare Research and Quality, the National Institutes of Health, the National Institute for Health Care Management Foundation, Health Care Services Corporation, Abbott Scientific, and the Patient-Centered Outcomes Research Institute outside the submitted work. Dr Bravata reported receiving personal fees from Castlight Health outside the submitted work. No other disclosures were reported.

Figures
Figure 1.. Unadjusted Utilization of Preventive, Nonelective,…

Figure 1.. Unadjusted Utilization of Preventive, Nonelective, Elective, and Pharmaceutical Services in January/February and March/April…
Figure 1.. Unadjusted Utilization of Preventive, Nonelective, Elective, and Pharmaceutical Services in January/February and March/April 2020 Compared With 2019

The colonoscopy (COL) population was limited to ages 46 to 64 years; mammogram (MMG) population, to women aged 46 to 64 years; vaccine population, to children aged 0 to 2 years; and labor and delivery population, to women aged 19 to 45 years. HbA_1c indicates hemoglobin A_1c; MMG, mammogram; MRI, magnetic resonance imaging; and MSK, musculoskeletal.

Figure 2.. Trends in Use of Office…

Figure 2.. Trends in Use of Office Visits and Telemedicine

This figure presents trends in…

Figure 2.. Trends in Use of Office Visits and Telemedicine

This figure presents trends in the monthly number of patients with an office visit (blue line) or a telemedicine visit (orange line) per 10 000 persons.

Figure 3.. Differences in Change in Preventive…

Figure 3.. Differences in Change in Preventive Care, Office-Based Visits, and Telehealth by Patient Zip…
Figure 3.. Differences in Change in Preventive Care, Office-Based Visits, and Telehealth by Patient Zip Code–Level Income and Race

This figure shows regression-adjusted changes in the monthly per-10 000 eligible persons use of preventive care (colonoscopy, mammograms, hemoglobin A_1c [HbA_1c] tests, vaccines), office visits, and telemedicine in March 2020. Panel A presents results by zip code income relative to the federal poverty line (FPL), and panel B presents results based on the share of residents that are White individuals or members of minority ethnic/racial groups (non-White). Regression models include fixed-effect controls for year and month, state, patient sex, and age category (categorized as 0-2, 3-18, 19-26, 27-45, and 46-64 years). The colonoscopy population is limited to ages 46 to 64 years; mammogram population, to women aged 46 to 64 years; and vaccine population, to children aged 0 to 2 years.