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Impact of Coronavirus Disease 2019 on Inpatient Palliative Care Services in Japan: A Hybrid Time-Series Analysis
Yuki Egashira1, Syo Nakamura1,2, Naoki Suzuki3
1Graduate School of Health Innovation, Kanagawa University of Human Services, Kawasaki-shi, Kanagawa, Japan.
Insights
The COVID-19 pandemic negatively impacted inpatient palliative care in Japan. Reclassifying COVID-19 led to a significant recovery in palliative care services, demonstrating the effectiveness of policy interventions.
Area of Science:
- Health Services Research
- Palliative Care Medicine
- Epidemiology
Background:
- The COVID-19 pandemic disrupted routine medical care, especially for non-life-threatening conditions.
- Previous research primarily focused on the early pandemic stages, neglecting later impacts and recovery phases.
Purpose of the Study:
- To analyze the influence of the COVID-19 pandemic on inpatient palliative care services in Japan.
- To assess the recovery of these services following COVID-19's reclassification to Category 5 infectious disease status.
Main Methods:
- Retrospective time-series analysis of national health insurance claims data (April 2014–March 2024).
- Calculation of observed-to-expected (OE) ratios using Seasonal Autoregressive Integrated Moving Average models.
- Interrupted time-series (ITS) analysis to evaluate changes post-COVID-19 reclassification in May 2023.
Main Results:
- Palliative Care Unit Inpatient Fee OE ratios fluctuated during COVID-19, reaching -36.0% in October 2022.
- Additional inpatient palliative care fees saw a low of -42.7% in February 2022.
- Following reclassification, both service types showed improved OE ratios and significant positive trends via ITS analysis.
Conclusions:
- The COVID-19 pandemic significantly affected inpatient palliative care, with impacts noted from the sixth wave onwards.
- Reclassification of COVID-19 to Category 5 resulted in immediate positive effects on palliative care services.
- Policy interventions are crucial for restoring healthcare services during pandemics and for future strategic planning in aging societies.
Background:
Coronavirus disease 2019 (COVID-19) reduced the use of routine medical care, particularly the treatment of nonlife-threatening conditions. Previous studies have examined the impact of the COVID-19 pandemic; however, most focused on the effect of early stages, lacking data on the later stages and post-pandemic recovery.
Objective:
To examine the impact of COVID-19 on inpatient palliative care services in Japan throughout the pandemic and after its reclassification as a Category 5 infectious disease.
Design:
Retrospective time-series analysis of claims data from April 2014 to March 2024.
Setting/Subjects:
National Health Insurance participants in Kanagawa Prefecture who received the "Palliative Care Unit Inpatient Fee" or "additional fee for inpatient palliative care treatment."
Measurements:
The observed-to-expected (OE) ratios were calculated using Seasonal Autoregressive Integrated Moving Average model predictions. Interrupted time-series (ITS) analysis was used to examine the level and trend changes after the reclassification of COVID-19 to Category 5 (May 2023).
Results:
During COVID-19, the Palliative Care Unit Inpatient Fee showed OE ratios ranging from -25.1% to 22.9% (April 2020-November 2021), which eventually reached -36.0% (October 2022). After COVID-19 reclassification, OE ratios improved to -9.5% to 12.5%. Additional fees for inpatient palliative care treatment showed similar patterns, with the lowest point being -42.7% (February 2022). The ITS analysis revealed significant positive trends for both services after reclassification.
Conclusions:
The COVID-19 pandemic has influenced inpatient palliative care services, particularly since its sixth wave. The reclassification of COVID-19 to Category 5 showed immediate positive effects, suggesting that policy interventions can effectively restore palliative care services. These findings highlight the vulnerability of palliative care, impact of policy interventions during pandemics, and need for strategic planning in a future-aging society.
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