The results of a new UCLA-led study show that the pandemic has exacerbated disparities in care, widening inequities.
Americans’ use of common outpatient health services dipped sharply at the outset of the COVID-19 pandemic, then rebounded to near-normal levels by the end of 2020, only to decline again between January and February 2021, the results of a new study from the University of California, Los Angeles (UCLA) show.1
But the 2020 recovery in care was not equal for all, investigators found. Some of the most socioeconomically disadvantaged patients — those with Medicaid or Medicare-Medicaid dual eligibility insurance — were far less likely than those with other insurance plans to return to using outpatient services at rates approaching normal, pre-pandemic levels.
The study, published in the Journal of the American Medical Association and based on data on 14.5 million adults in the United States, raises concerns about patients delaying preventive care, lacking a clear understanding of when to seek help, and missing treatments for acute illnesses during the pandemic, lead author John Mafi, MD, an associate professor of medicine and practicing general internist at the David Geffen School of Medicine at UCLA, said in a statement.
“The worsening access to care we observed among socioeconomically disadvantaged Americans is particularly concerning, because it suggests that the pandemic is widening inequities in access to vital health services, such as emergency care, preventive cancer screening, and behavioral health services,” John Mafi, MD, an associate professor of medicine and practicing general internist at the David Geffen School of Medicine at UCLA, said in the statement.
Investigators examined the use of 6 types of ambulatory care services: doctors’ office or urgent-care visits, behavioral health services, colonoscopy screenings, contraception counseling and HIV screenings, emergency department visits, and mammogram screenings.
They compared the use of those services among individuals with commercial insurance, Medicare Advantage, Medicare fee-for-service insurance, and those with Medicaid or Medicare-Medicaid dual eligibility between January 1, 2019, and February 28, 2021. Patient data were drawn from the Milliman MedInsight Emerging Experience research database and included information on individuals from all US states.
Investigators found that during the initial COVID-19 surge between March 2020 and April 2020, the overall use of the 6 types of ambulatory care services dropped to just 67% of levels that would be expected had the pandemic not occurred.
In those months of the pandemic, the Centers for Medicare and Medicaid Services instructed hospitals and medical practices across the United States to curb some outpatient services to preserve resources for more critical care and to minimize COVID-19 transmission, investigators said.
Additionally, many individuals cancelled outpatient appointments out of fear of contracting the virus.
As a result, many individuals did not receive the outpatient care they otherwise would have.
By November 2020 to December 2020, the use of the 6 types of outpatient services met 97% of expected rates. However, during the second surge from January 2021 to February 2021, overall use dropped again, to 86% of expected rates.
Investigators found that the return to expected rates varied by insurance type with commercial insurance rates at 91%, Medicare Advantage at 83%, Medicare fee-for-service at 81%, Medicaid at 78%, and Medicare-Medicaid dual eligibility at 73%.
The investigators accounted for potential changes to the study population during the pandemic, adjusted for patient characteristics, such as age, national origin, and sex.