Preventive Healthcare Declines During COVID-19 Pandemic

A pioneering study confirms that Americans dramatically cut back on preventive and elective healthcare during the COVID-19 pandemic’s first two months. The research also reveals the increasing use of telemedicine—but not at rates high enough to offset reduced in-person care.

Published by JAMA Open Network, the study found that overall healthcare use declined by 23% in March 2020 and 52% in April. Drops in diagnostic procedures unable to be conducted by telemedicine were especially precipitous. In March and April, colonoscopies decreased by nearly 70% when compared to the same period in 2019. Meanwhile, reductions in mammograms were 67% among women age 46 to 64.

“We expected some drop in preventive and elective care—but not to this magnitude,” says Neeraj Sood, study co-author, director of the COVID Initiative at the USC Schaeffer Center and vice dean of research at the USC Price School of Public Policy.

The investigators examined data from 6.8 million people who have employer-provided insurance. To address concerns that the pandemic disproportionately affects vulnerable populations, the researchers also analyzed care differences based on income, ethnicity and ZIP code.

The team noted declines of 45% or more in cataract surgeries, musculoskeletal procedures and magnetic resonance imaging (MRI) services, along with a 22% drop in vaccine delivery to children under age 2. Blood sugar tests dropped by more than 50% and angioplasties by nearly 17%. Small reductions were also found in chemotherapy treatments and prescriptions for high cholesterol and diabetes. Asthma medications were an exception to the trend, with an 11% uptick in use.

“This adds detailed evidence to the anecdotal reports that Americans quit going to see the doctor when the pandemic shutdown started,” says Christopher Whaley, the study’s lead author and a policy researcher at the nonprofit RAND Corporation.

Telemedicine visits, however, skyrocketed by more than 4,000% in April—but the rise still only offset about 40% of the decline in medical office visits. Much of the surge occurred in wealthier ZIP codes, with the increase being about a third less in lower-income and predominately non-white neighborhoods.

If the observed reductions in care were only temporary deferrals, then the impacts on patients’ health will be limited, according to the authors. If, however, people keep putting off doctor’s visits out of fear of COVID-19, substantial harm may result.

“These are high-value services that really have to be done in person,” Sood says. “And if this pattern continues, COVID-19 may have ripple effects on other aspects of our health.”

Preventing this, the authors contend, may require innovative approaches and partnerships among healthcare providers, insurers, regulators, employers and—most importantly—patients to ensure timely use of necessary care.

While most analyses of the COVID-19 pandemic’s impact on medical care have relied on information from a single health system or geographic market, this new research used insurance claims data from nearly 200 employers spanning all 50 states.

In addition to Sood and Whaley, the study was authored by Megan Pera, Jonathan Cantor, Jennie Chang, Julia Velasco, Heather Hagg, and Dena Bravata.