Impact of the COVID-19 Pandemic on Health Care Utilization in a Large Integrated Health Care System: Retrospective Cohort Study

J Med Internet Res. 2021 Apr 29;23(4):e26558. doi: 10.2196/26558.


Background: The COVID-19 pandemic has caused an abrupt reduction in the use of in-person health care, accompanied by a corresponding surge in the use of telehealth services. However, the extent and nature of changes in health care utilization during the pandemic may differ by care setting. Knowledge of the impact of the pandemic on health care utilization is important to health care organizations and policy makers.

Objective: The aims of this study are (1) to evaluate changes in in-person health care utilization and telehealth visits during the COVID-19 pandemic and (2) to assess the difference in changes in health care utilization between the pandemic year 2020 and the prepandemic year 2019.

Methods: We retrospectively assembled a cohort consisting of members of a large integrated health care organization, who were enrolled between January 6 and November 2, 2019 (prepandemic year), and between January 5 and October 31, 2020 (pandemic year). The rates of visits were calculated weekly for four settings: inpatient, emergency department (ED), outpatient, and telehealth. Using Poisson models, we assessed the impact of the pandemic on health care utilization during the early days of the pandemic and conducted difference-in-deference (DID) analyses to measure the changes in health care utilization, adjusting for the trend of health care utilization in the prepandemic year.

Results: In the early days of the pandemic, we observed significant reductions in inpatient, ED, and outpatient utilization (by 30.2%, 37.0%, and 80.9%, respectively). By contrast, there was a 4-fold increase in telehealth visits between weeks 8 (February 23) and 12 (March 22) in 2020. DID analyses revealed that after adjusting for prepandemic secular trends, the reductions in inpatient, ED, and outpatient visit rates in the early days of the pandemic were 1.6, 8.9, and 367.2 visits per 100 person-years (P<.001), respectively, while the increase in telehealth visits was 272.9 visits per 100 person-years (P<.001). Further analyses suggested that the increase in telehealth visits offset the reduction in outpatient visits by week 26 (June 28, 2020).

Conclusions: In-person health care utilization decreased drastically during the early period of the pandemic, but there was a corresponding increase in telehealth visits during the same period. By end-June 2020, the combined outpatient and telehealth visits had recovered to prepandemic levels.

Keywords: COVID-19; cohort; difference-in-difference analysis; health care utilization; health care worker; impact; knowledge; pandemic; policy; retrospective; telehealth; telemedicine; usage; utilization.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • COVID-19 / epidemiology*
  • Child
  • Child, Preschool
  • Delivery of Health Care, Integrated / statistics & numerical data*
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Inpatients / statistics & numerical data*
  • Male
  • Middle Aged
  • Outpatients / statistics & numerical data*
  • Pandemics*
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Retrospective Studies
  • SARS-CoV-2
  • Telemedicine / statistics & numerical data*
  • Young Adult