(213) Understanding The Impact of the COVID-19 Pandemic on Disease Burden Among Medicaid Patients in the United States: An Analysis of Alterations in Healthcare Resource Utilization
Background: There have been fundamental shifts in healthcare access during the COVID-19 pandemic in the US. These alterations are driven by both overburdened health systems and patients avoiding care due to risk of infection and may carry long term implications for disease burden.
Objectives: This study assessed quarterly healthcare resource utilization for patients with pregnancy, type 2 diabetes (T2D), breast cancer (BC) and colorectal cancer (CRC) over 2020 to quantify alterations in disease management trends during the pandemic in a Medicaid population.
Methods: Calendar year cohorts of adults diagnosed with pregnancy, T2D, BC, or CRC in 2018 or 2020 were defined. Patients had to be continuously enrolled in the MarketScan Multi-state Medicaid database for the calendar year of interest and 6 months prior. Changes in quarterly healthcare resource utilization, relative to Q1 of the calendar year, were assessed in the 2018 (control) and 2020 (COVID-19) cohorts to examine the impact of the COVID-19 pandemic on disease management.
Results: There were universal reductions in healthcare resource use in 2020 compared to 2018. In the T2D and cancer cohorts the greatest losses in care were observed in Q2 2020 when the pandemic hit the US. T2D patients had notable reductions in Q2 ER (-25%) and office (-17%) visits; although rates of service use increased over Q3/Q4, they did not return to Q1 levels. Cancer patients showed universal declines in resource use in all sites of care over 2020; the greatest Q2 decreases were observed for IP admissions (-21% in CRC and -70% in BC) and ER visits (-23% in CRC and -38% in BC); rates of service use generally remained below Q1 levels for the rest of 2020. The pregnancy sample evidenced the greatest utilization of services during Q1 in both 2018 and 2020; however, declines in Q2-Q4 service use were greater in 2020. By Q2 2020 the proportion of women with 1 office, ER, or IP visit had declined -33%, -33%, and -18% respectively. After Q2 rates of ER use were relatively static but rates of IP and office visits continued to decline throughout the year.
Conclusions: Declines in resource use in office, ER, and inpatient settings within this Medicaid population indicate that the pandemic shifted patient disease management priorities. The reductions in both preventative and acute care observed here may have longer reaching consequences for disease burden, both for individuals and the US healthcare system at large.
