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Procedure Prioritization During a Nationwide Ban on Non-Urgent Healthcare: A Quasi-Experimental Retrospective Study
Thomas Grischott1, Tarun Mehra2, Matthias R Meyer1,3
1Institute of Primary Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Insights
During the COVID-19 lockdown, Switzerland limited non-urgent healthcare. This study found no evidence that factors other than medical urgency affected healthcare prioritization for hospitalized patients.
Area of Science:
- Healthcare policy and management
- Epidemiology
- Health services research
Background:
- During the COVID-19 pandemic's spring 2020 lockdown, Switzerland restricted non-urgent healthcare services.
- The study aimed to determine if demographic factors or financial incentives influenced hospital resource allocation, despite intended prioritization by medical urgency.
Purpose of the Study:
- To investigate potential determinants of procedure prioritization in hospitalized patients during the COVID-19 lockdown in Switzerland.
- To assess whether factors beyond medical urgency influenced healthcare resource allocation decisions.
Main Methods:
- A quasi-experimental retrospective study analyzed data from 496,456 adult patients in Switzerland admitted between January 2017 and April 2020.
- Negative binomial regression was used to calculate admission rate ratios (ARRs) for procedure-diagnosis combinations before and during the lockdown.
- Statistical tests compared ARRs across different demographic and insurance strata.
Main Results:
- Significant reductions in admission rates were observed for 29 out of 53 procedure-diagnosis combinations during the lockdown.
- Orthopedic procedures for osteoarthritis and joint disorders saw the largest decreases, while cerebral imaging for stroke and oncological surgeries had the smallest reductions.
- A notable finding was a stronger decrease in cardiovascular procedure admissions for patients with private versus basic health insurance.
Conclusions:
- While the COVID-19 lockdown impacted medical procedures, no robust evidence suggests that factors other than medical urgency influenced healthcare prioritization.
- The study highlights variations in procedure impact and a potential disparity based on insurance status for cardiovascular care.
Background:
During the COVID-19 lockdown in spring 2020, Switzerland restricted non-urgent healthcare services to safeguard capacity. While prioritization of care was supposed to be driven by medical urgency, demographic factors or economic incentives might have influenced the hospitals' resource allocation decisions.
Objectives:
This study investigates potential determinants of procedure prioritization in hospitalized patients during the lockdown period.
Design:
Quasi-experimental retrospective study of hospital data in Switzerland.
Methods:
We analyzed 496 456 adult patients with known insurance status and a recorded procedure, admitted for cardiovascular, orthopedic/musculoskeletal or oncological reasons from January 2017 (3 years before the COVID-19 outbreak) to mid-April 2020 (in the first year of the COVID-19 pandemic), to obtain admission rate ratios (ARRs, "lockdown" admission rates divided by "normal" rates) from negative binomial regression analysis of fortnightly admissions for frequent procedure-diagnosis combinations. Quade and Wilcoxon signed-rank tests compared ARRs between sex×age, insurance and comorbidity strata.
Results:
Admission rates showed significant reductions for 29 of 53 procedure-diagnosis combinations. Reductions varied strongly by emergency, with largest decreases in orthopedic procedures for arthrosis (osteoarthritis) and non-arthritic joint disorders, and the smallest in cerebral imaging for stroke patients and surgical procedures for malignant neoplasms. The only difference in ARRs between strata was a stronger decrease in admission rates for cardiovascular combinations for patients with private versus basic health insurance.
Conclusion:
While medical procedures were affected to varying degrees by the ban on non-urgent healthcare during the COVID-19 lockdown, we found no robust evidence that factors other than medical urgency influenced healthcare prioritization.
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