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Measuring voluntary responses in healthcare utilization during the COVID-19 pandemic: Evidence from Taiwan
1Truman School of Government and Public Affairs, University of Missouri, Columbia, MO, United States of America.
Insights
During the COVID-19 pandemic, people voluntarily reduced healthcare use, decreasing outpatient visits by 19% and inpatient admissions by 10%. This decline persisted even without restrictions, driven by contagion fears and precautionary behaviors.
Area of Science:
- Public Health
- Health Economics
- Epidemiology
Background:
- The COVID-19 pandemic significantly impacted healthcare utilization globally.
- Understanding the drivers of reduced healthcare use (voluntary vs. enforced) is crucial for public health policy.
Purpose of the Study:
- To quantify the spontaneous changes in healthcare utilization during the COVID-19 pandemic in Taiwan.
- To differentiate between voluntary reductions in healthcare demand and impacts of enforced measures.
Main Methods:
- Utilized a county-by-week-level dataset from Taiwan's National Health Insurance (NHI) records.
- Employed a difference-in-differences research design to analyze changes in healthcare utilization.
- Analyzed trends for both COVID-19 and non-COVID-19 related illnesses, including Influenza-like Illness (ILI).
Main Results:
- Outpatient visits decreased by 19% and inpatient admissions by 10% during February-May 2020.
- Healthcare demand reduction was voluntary, driven by contagion fears and precautionary behaviors, not mobility restrictions.
- Demand for ILI-related healthcare saw a greater and more persistent decrease compared to non-ILI care.
- Healthcare utilization did not return to pre-pandemic levels even after 253 consecutive days without local COVID-19 cases.
Conclusions:
- Voluntary behavioral changes, primarily fear of contagion, significantly reduced healthcare utilization during the pandemic.
- Public health prevention measures created a positive externality, leading to decreased demand for non-COVID-19 healthcare.
- Sustained reduction in healthcare demand highlights the long-term behavioral impacts of the pandemic.
Abstract:
Healthcare has been one of the most affected sectors during the coronavirus disease 2019 (COVID-19) pandemic. The utilization of related services for non-COVID-19 diseases fell dramatically following the point at which the virus broke out; however, little is known about whether this observed decline in healthcare use was due to voluntary behaviors or enforced measures. This paper quantifies the spontaneous change in healthcare utilization during the pandemic. We utilize a county-by-week-level dataset from Taiwan's National Health Insurance (NHI) record, covering the entire Taiwanese population, and a difference-in-differences design. Our results indicate that even if there were no human mobility restrictions or supply-side constraints, people voluntarily reduced their demand for healthcare, due to fears of contagion, or COVID-related precautionary behaviors. We find that the number of outpatient visits (inpatient admissions) decreased by 19% (10%) during the pandemic period (February to May 2020). Furthermore, the demand response of healthcare for Influenza-like illness (ILI) was much greater and more persistent than for non-ILI, thereby suggesting that the substantial decline in accessing healthcare was induced by positive public health externality of prevention measures for COVID-19. Finally, we find that the demand for healthcare services did not get back to the pre-pandemic baseline, even when there were no local coronavirus cases for 253 consecutive days (mid-April to December 2020) in Taiwan.
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