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Article: The road to recovery: impact of COVID-19 on healthcare utilization in South Korea in 2016–2022 using an interrupted time-series analysis

TitleThe road to recovery: impact of COVID-19 on healthcare utilization in South Korea in 2016–2022 using an interrupted time-series analysis
Authors
KeywordsAge
Aging population
Avoidable/non-avoidable hospitalizations
Elderly
Health facility type
Health service utilization
Impact of COVID-19
Income level
Interrupted time-series analysis
Low-income
Low-income level
Medicaid
National health insurance service
Negative binomial model
Road to recovery
Sex
South Korea
Type of healthcare services
Vulnerable populations
Issue Date1-Dec-2023
PublisherElsevier Ltd.
Citation
The Lancet Regional Health - Western Pacific, 2023, v. 41 How to Cite?
Abstract

Background

The COVID-19 pandemic substantially disrupted healthcare utilization patterns, globally. South Korea had been praised widely in its efforts to contain the spread of the pandemic, which may have contributed to a significantly smaller reduction in healthcare utilization compared to neighboring countries. However, it remains unknown how the COVID-19 pandemic impacted utilization patterns across population sub-groups, particularly vulnerable patient groups in South Korea. This paper quantifies the changes in healthcare utilization attributable to COVID-19 and the COVID-19 vaccination by sub-groups.

Methods

An interrupted time series analysis was conducted to examine the impact of COVID-19 on healthcare utilization in South Korea from January 2016 to December 2022 using aggregated patient-level data from the national health insurance system that accounts for 99% of all healthcare services in South Korea. We applied negative binomial models adjusting for seasonality and serial correlation. Falsification tests were conducted to test the validity of breakpoints. Stratified analyses by type of healthcare services, age, sex, income level, health facility type, and avoidable/non-avoidable hospitalizations was performed, and we assessed differences in utilization trends between population groups across three phases of the pandemic.

Findings

In early 2020, the COVID-19 pandemic caused a reduction in monthly volume of outpatient utilization by 15.7% [95% CI 13.3%–18.1%, p < 0.001] and inpatient utilization by 11.6% [10.1%–13.0%, p < 0.001]. Most utilization recovered and rebounded to pre-COVID-19 levels as of December 2022 although variations existed. We observed heterogeneity in the magnitude of relative changes in utilization across types of services, varying from a 42.7% [36.8%–48.0%, p < 0.001] decrease for pediatrics, a 23.4% [20.1%–26.5%%, p < 0.001] reduction in utilization of public health centers, and a 24.2% [21.2%–27.0%, p < 0.001] reduction in avoidable hospitalizations compared to the pre-pandemic period. Contrary to global trends, health utilization among the elderly population (65 and older) in South Korea saw only marginal reductions compared to other age groups. Similarly, Medicaid patients and lower income groups experienced a smaller reduction compared to higher income groups.

Interpretation

The impact of the COVID-19 pandemic on healthcare utilization in South Korea was less pronounced compared to the global average. Utilization of vulnerable populations, including adults over 65 years old and lowest-income groups reduced less than other type of patients.


Persistent Identifierhttp://hdl.handle.net/10722/338837
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorYoo, KJ-
dc.contributor.authorLee, Y-
dc.contributor.authorLee, S-
dc.contributor.authorFriebel, R-
dc.contributor.authorShin, Sa-
dc.contributor.authorLee, T-
dc.contributor.authorBishai, D-
dc.date.accessioned2024-03-11T10:31:55Z-
dc.date.available2024-03-11T10:31:55Z-
dc.date.issued2023-12-01-
dc.identifier.citationThe Lancet Regional Health - Western Pacific, 2023, v. 41-
dc.identifier.urihttp://hdl.handle.net/10722/338837-
dc.description.abstract<h3>Background</h3><p>The COVID-19 pandemic substantially disrupted healthcare utilization patterns, globally. South Korea had been praised widely in its efforts to contain the spread of the pandemic, which may have contributed to a significantly smaller reduction in healthcare utilization compared to neighboring countries. However, it remains unknown how the COVID-19 pandemic impacted utilization patterns across population sub-groups, particularly vulnerable patient groups in South Korea. This paper quantifies the changes in healthcare utilization attributable to COVID-19 and the COVID-19 vaccination by sub-groups.</p><h3>Methods</h3><p>An interrupted time series analysis was conducted to examine the impact of COVID-19 on healthcare utilization in South Korea from January 2016 to December 2022 using aggregated patient-level data from the national health insurance system that accounts for 99% of all healthcare services in South Korea. We applied negative binomial models adjusting for seasonality and serial correlation. Falsification tests were conducted to test the validity of breakpoints. Stratified analyses by type of healthcare services, age, sex, income level, health facility type, and avoidable/non-avoidable hospitalizations was performed, and we assessed differences in utilization trends between population groups across three phases of the pandemic.</p><h3>Findings</h3><p>In early 2020, the COVID-19 pandemic caused a reduction in monthly volume of outpatient utilization by 15.7% [95% CI 13.3%–18.1%, p < 0.001] and inpatient utilization by 11.6% [10.1%–13.0%, p < 0.001]. Most utilization recovered and rebounded to pre-COVID-19 levels as of December 2022 although variations existed. We observed heterogeneity in the magnitude of relative changes in utilization across types of services, varying from a 42.7% [36.8%–48.0%, p < 0.001] decrease for pediatrics, a 23.4% [20.1%–26.5%%, p < 0.001] reduction in utilization of public health centers, and a 24.2% [21.2%–27.0%, p < 0.001] reduction in avoidable hospitalizations compared to the pre-pandemic period. Contrary to global trends, health utilization among the elderly population (65 and older) in South Korea saw only marginal reductions compared to other age groups. Similarly, Medicaid patients and lower income groups experienced a smaller reduction compared to higher income groups.</p><h3>Interpretation</h3><p>The impact of the COVID-19 pandemic on healthcare utilization in South Korea was less pronounced compared to the global average. Utilization of vulnerable populations, including adults over 65 years old and lowest-income groups reduced less than other type of patients.</p>-
dc.languageeng-
dc.publisherElsevier Ltd.-
dc.relation.ispartofThe Lancet Regional Health - Western Pacific-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectAge-
dc.subjectAging population-
dc.subjectAvoidable/non-avoidable hospitalizations-
dc.subjectElderly-
dc.subjectHealth facility type-
dc.subjectHealth service utilization-
dc.subjectImpact of COVID-19-
dc.subjectIncome level-
dc.subjectInterrupted time-series analysis-
dc.subjectLow-income-
dc.subjectLow-income level-
dc.subjectMedicaid-
dc.subjectNational health insurance service-
dc.subjectNegative binomial model-
dc.subjectRoad to recovery-
dc.subjectSex-
dc.subjectSouth Korea-
dc.subjectType of healthcare services-
dc.subjectVulnerable populations-
dc.titleThe road to recovery: impact of COVID-19 on healthcare utilization in South Korea in 2016–2022 using an interrupted time-series analysis-
dc.typeArticle-
dc.identifier.doi10.1016/j.lanwpc.2023.100904-
dc.identifier.scopuseid_2-s2.0-85171552844-
dc.identifier.volume41-
dc.identifier.eissn2666-6065-
dc.identifier.isiWOS:001084379300001-
dc.identifier.issnl2666-6065-

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