The impact of the COVID-19 pandemic and related policy responses on non-COVID-19 healthcare utilization in China

Impact of the targeted poverty alleviation policy on older adults' healthcare utilization: A quasi-experimental analysis from China

China implemented the Targeted Poverty Alleviation (TPA) policy in 2015 to fight against poverty. In order to assess the health performance of the TPA policy, this study aims to evaluate the impact of the TPA policy on healthcare utilization among older adults who normally have higher vulnerability to poverty and diseases. Drawing on data from four waves of the China Health and Retirement Longitudinal Study (CHARLS), we investigated the impact of the TPA policy on older individuals' outpatient and inpatient utilization using the difference-in-differences (DID) approach. In total, 5285 older respondents were incorporated into a final sample. The results indicated that the implementation of the TPA policy had a significantly positive impact on increasing inpatient care utilization for poor older adults. However, its impact on outpatient service utilization was not significant. To ensure that the increased level of inpatient care utilization was not caused by deteriorating health status, we further analyzed the impact of the TPA policy on poor older adults' health outcomes. Results indicated that the TPA policy improved self-rated health and reduced the number of ADL limitations among older adults in registered poor households. The positive impact of the TPA policy on inpatient care utilization was found to be most beneficial for older adults in poor households who were female, coupled, and aged 70 years and above. The TPA policy in China improved healthcare access for economically disadvantaged older adults and contributed to the enhancement of their health outcomes. This evidence may have broad implications for other low- and middle-income countries aiming to reduce poverty and achieve health equity.

Characteristics and influencing factors of caregivers' healthcare preferences for young children under COVID-19 lockdown: a cross-sectional study in Shanghai, China

BACKGROUND

Missed or delayed child healthcare caused by the COVID-19 lockdown has threatened young children's health and has had an unpredictable influence on caregivers' child healthcare preferences. This study investigated caregivers' child healthcare preferences and the factors that influence them among families with young children (0-3 years) during the lockdown in Shanghai.

METHODS

Participants in this cross-sectional study were enrolled through random encounter sampling. Questionnaires were distributed online from June 1 to November 10, 2022, in Shanghai. A total of 477 valid questionnaires were received. The demographics of caregivers and their families, children's characteristics, COVID-19-related information, and caregivers' healthcare preferences were analyzed. The statistical analyses included frequency and percentage, chi-square tests, and multinomial logistic regression.

RESULTS

Caregivers preferred child healthcare professionals in the community health service system (CHS; 47.6%) followed by hospital pediatricians (40.0%) during lockdown. Caregivers with the following characteristics preferred CHS: those with an annual household income of CNY 200,000-300,000, those whose youngest children were aged 8-12 months, and those who experienced early childhood physical development issues. Caregivers preferred hospitals if they had experienced healthcare-seeking-related difficulties in accessing professional guidance from hospital pediatricians.

CONCLUSIONS

During pandemic lockdowns, policymakers should allocate more resources to CHS to meet caregivers' childcare demands. Moreover, special attention should be given to the healthcare needs for CHS among families with specific demographics.

TRIAL REGISTRATION

Approval was obtained from the Ethics Committee of Shanghai Jiao Tong University School of Medicine School of Public Health (SJUPN-202,109; June 1, 2022).

Public Health Impact of Paxlovid as Treatment for COVID-19, United States

We evaluated the population-level benefits of expanding treatment with the antiviral drug Paxlovid (nirmatrelvir/ritonavir) in the United States for SARS-CoV-2 Omicron variant infections. Using a multiscale mathematical model, we found that treating 20% of symptomatic case-patients with Paxlovid over a period of 300 days beginning in January 2022 resulted in life and cost savings. In a low-transmission scenario (effective reproduction number of 1.2), this approach could avert 0.28 million (95% CI 0.03-0.59 million) hospitalizations and save US $56.95 billion (95% CI US $2.62-$122.63 billion). In a higher transmission scenario (effective reproduction number of 3), the benefits increase, potentially preventing 0.85 million (95% CI 0.36-1.38 million) hospitalizations and saving US $170.17 billion (95% CI US $60.49-$286.14 billion). Our findings suggest that timely and widespread use of Paxlovid could be an effective and economical approach to mitigate the effects of COVID-19.

Effects of private health insurance on healthcare services during the MERS Pandemic: Evidence from Korea

This study investigates how private health insurance impacted healthcare services during the MERS pandemic in Korea. Using the Korea Health Panel Study (KHPS), this study examines the difference in healthcare utilization between insured and uninsured individuals during the pandemic. If insured individuals use fewer healthcare services than the uninsured during the MERS pandemic, it could be evidence of moral hazard. During the MERS outbreak, the probability of outpatient medical services utilization was lower by 19 % than during non-pandemic periods. All individuals decreased the number of outpatient visits by 7 %. Insured individuals reduced outpatient visits more than the uninsured in response to the MERS pandemic. The increased outpatient utilization by private health insurance could be attributed to both moral hazard and adverse selection. However, given that people with poor health cannot enroll in private health insurance due to the insurance company's screening process, moral hazard leads to increase healthcare utilization rather than adverse selection.

The public health impact of Paxlovid COVID-19 treatment in the United States

The antiviral drug Paxlovid has been shown to rapidly reduce viral load. Coupled with vaccination, timely administration of safe and effective antivirals could provide a path towards managing COVID-19 without restrictive non-pharmaceutical measures. Here, we estimate the population-level impacts of expanding treatment with Paxlovid in the US using a multi-scale mathematical model of SARS-CoV-2 transmission that incorporates the within-host viral load dynamics of the Omicron variant. We find that, under a low transmission scenario R e ∼ 1.2 treating 20% of symptomatic cases would be life and cost saving, leading to an estimated 0.26 (95% CrI: 0.03, 0.59) million hospitalizations averted, 30.61 (95% CrI: 1.69, 71.15) thousand deaths averted, and US$52.16 (95% CrI: 2.62, 122.63) billion reduction in health- and treatment-related costs. Rapid and broad use of the antiviral Paxlovid could substantially reduce COVID-19 morbidity and mortality, while averting socioeconomic hardship.

The effect of Covid-19 pandemic on healthcare utilization in public vs private centers in Iran: a multiple group interrupted time-series analysis

BACKGROUND

The outbreak of Coronavirus in late 2019 and its continuation in the following years has affected all human societies, government organizations, and health systems. Access to health services is an important issue during crises. The present study aimed to investigate the effect of the Covid-19 pandemic on the consumption of health services in the public sector compared to the private sector in Iran.

METHODS

The research population consisted of all insured individuals covered by Iran Health Insurance Organization in Fars province, which amounts to approximately 2,700,000 people. The required information including the utilization of laboratory, radiology, medicine, and hospitalization services was extracted on a monthly basis from February 2019 to February 2021. The Multiple Group Interrupted Time Series Analysis (MGITSA) was used for data analysis along with STATA.15 software.

RESULTS

According to the findings of MGITSA, in the short-term, the utilization of private laboratory, radiology, medication, and hospital admissions had decreased by approximately 18,066, 8210, 135,445, and 1086 times, respectively (P < 0.05). In the long-run, the use of laboratory and radiology services had increased by about 2312 and 514 times (P < 0.05), respectively. The comparison between the public and private sectors showed that in the short-term, the use of radiology services decreased by about 12,525, while the use of medication increased by about 91,471 times (P < 0.05). In the long-run, the use of laboratory services decreased by about 1514 times (P = 0.076) and no change was observed in the other services utilization (in public relative to private centers).

CONCLUSIONS

Utilization of health services in the public versus private centers, except for medication and hospitalization, significantly decreased in the short-term. However the utilization of most services returned to the usual trend in the long-term. The reduction in access to health services could impose a significant burden of various diseases, at least in the short-term, and increase health costs in the coming years.

Cyber-infrastructure and epidemic precautionary policy: evidence from China

Introduction

The application of technology supported by cyber infrastructure has emerged as a critical factor influencing city management. This study aims to investigate whether the development of cyber infrastructure can enhance cities' confidence in responding to potential epidemic threats in the context of COVID-19.

Methods

China serves as a good example for both COVID-19 management and smart city construction. We take advantage of a special time point, the 2022 Chinese New Year, to observe cities' precautionary epidemic policies. We utilize choice models and data from 188 Chinese cities to examine the impact of internet coverage on the degree of policy relaxation.

Results

We found that cities with higher internet coverage tend to adopt looser policies. In the benchmark regression, for every 1 percentage point increase in internet coverage, the likelihood of implementing loose measures increases by 0.9 percentage points. This result remains robust across different classifications of policies. We also addressed potential endogeneity issues by using the instrumental variables method.

Discussion

Our study indicates that effective management of epidemics in the modern era requires not only the utilization of traditional medical resources but also the incorporation of new city features, such as information technology infrastructure.