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Health Care and Social Service Utilization Before, During, and After the COVID-19 Pandemic: An Integrated Data
Carlene A Mayfield1, Liping Tong, Rachel George
1Author Affiliations: Advocate National Center for Clinical and Community Impact, Advocate Health, Charlotte, North Carolina (Dr Mayfield, Dr Tong, Dr George, Ms Mejia); Urban Institute, University of North Carolina at Charlotte, Charlotte, North Carolina (Dr Venkitasubramanian); Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina (Dr Foley).
Journal of Public Health Management and Practice : JPHMP
|August 10, 2026
Summary
The COVID-19 pandemic initially reduced healthcare visits but increased social service needs. Utilizing social services during the pandemic was linked to better healthcare access and lower mortality rates during recovery.
Area of Science:
- Public Health
- Health Services Research
- Social Determinants of Health
Background:
- The COVID-19 pandemic significantly disrupted healthcare access and worsened social needs.
- Fragmented data systems hinder coordinated responses between health and social services.
Purpose of the Study:
- To analyze changes in healthcare and social service utilization before, during, and after COVID-19 using integrated data.
- To investigate the association between social service use and subsequent healthcare utilization and mortality.
Main Methods:
- Retrospective longitudinal study with difference-in-differences analysis.
- Utilized integrated health system and social service data from Mecklenburg County, NC (Sept 2018-Aug 2021).
- Included 28,258 adult patients from a safety-net clinic, analyzing monthly healthcare visits and social service utilization.
Main Results:
- Healthcare visits decreased early in the pandemic but recovered by late 2020; emergency department visits shifted to higher acuity.
- Social service utilization increased steadily throughout the pandemic and recovery periods, primarily for food assistance.
- Pandemic-era social service utilization correlated with increased clinic visits and decreased mortality during recovery.
Conclusions:
- Healthcare utilization patterns normalized post-pandemic, while social service needs remained elevated, indicating persistent community challenges.
- Integrated data revealed that social services may help mitigate adverse health outcomes.
- Sustaining safety nets and integrated data infrastructure is crucial for resilient public health responses.
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