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Reduction in healthcare services during the COVID-19 pandemic in China
Yi-Na Zhang1, Yun Chen2, Ying Wang2
1Department of Socail Management and Socail Policy, School of Social Development and Public Policy, Fudan University, Shanghai, China.
Insights
The COVID-19 pandemic significantly reduced healthcare utilization and expenditure in China. While services gradually recovered, they remained below pre-pandemic levels by April 2020.
Area of Science:
- Public Health
- Health Economics
- Epidemiology
Background:
- The COVID-19 pandemic created a global healthcare crisis, significantly impacting healthcare service utilization and expenditure.
- Understanding the pandemic's specific effects on national and regional healthcare systems is crucial for effective public health response.
Purpose of the Study:
- To evaluate the impact of the COVID-19 pandemic on national and regional healthcare service utilization and expenditure in China.
- To quantify changes in healthcare utilization and expenditure before, during, and after the 2020 Chinese Spring Festival holiday.
Main Methods:
- Utilized a big data approach analyzing 300 million bank card transactions for individual healthcare expenditure and utilization data in mainland China.
- Employed a difference-in-difference (DID) method comparing healthcare utilization changes between 2020 and 2019, coinciding with the Chinese Spring Festival holiday and the COVID-19 outbreak.
Main Results:
- Overall healthcare utilization and expenditure declined significantly (40.8% and 37.8%, respectively), with a 3.3% increase in per capita expenditure.
- High-risk cities and those in the western region experienced greater impacts; DID analysis showed significant reductions in healthcare expenditure and utilization in medium-risk, high-risk, and Hubei province cities post-festival 2020 compared to 2019.
- By late April 2020, healthcare utilization recovered partially, reaching 79.9%-89.3% of pre-outbreak levels.
Conclusions:
- The COVID-19 pandemic exerted a substantial negative influence on healthcare utilization in China, marked by a sharp decrease in healthcare expenditure.
- Despite gradual recovery post-outbreak, healthcare utilization had not returned to normal levels by April 2020.
Introduction:
The COVID-19 pandemic caused a healthcare crisis in China and continues to wreak havoc across the world. This paper evaluated COVID-19's impact on national and regional healthcare service utilisation and expenditure in China.
Methods:
Using a big data approach, we collected data from 300 million bank card transactions to measure individual healthcare expenditure and utilisation in mainland China. Since the outbreak coincided with the 2020 Chinese Spring Festival holiday, a difference-in-difference (DID) method was employed to compare changes in healthcare utilisation before, during and after the Spring Festival in 2020 and 2019. We also tracked healthcare utilisation before, during and after the outbreak.
Results:
Healthcare utilisation declined overall, especially during the post-festival period in 2020. Total healthcare expenditure and utilisation declined by 37.8% and 40.8%, respectively, while per capita expenditure increased by 3.3%. In a subgroup analysis, we found that the outbreak had a greater impact on healthcare utilisation in cities at higher risk of COVID-19, with stricter lockdown measures and those located in the western region. The DID results suggest that, compared with low-risk cities, the pandemic induced a 14.8%, 26.4% and 27.5% reduction in total healthcare expenditure in medium-risk and high-risk cities, and in cities located in Hubei province during the post-festival period in 2020 relative to 2019, an 8.6%, 15.9% and 24.4% reduction in utilisation services; and a 7.3% and 18.4% reduction in per capita expenditure in medium-risk and high-risk cities, respectively. By the last week of April 2020, as the outbreak came under control, healthcare utilisation gradually recovered, but only to 79.9%-89.3% of its pre-outbreak levels.
Conclusion:
The COVID-19 pandemic had a significantly negative effect on healthcare utilisation in China, evident by a dramatic decline in healthcare expenditure. While the utilisation level has gradually increased post-outbreak, it has yet to return to normal levels.
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