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Examining the decline in healthcare utilization in California during COVID-19

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California Healthcare System Tracking Project

In the wake of the COVID-19 pandemic, I did some contract work with my former athenahealth boss, Josh Gray, for Manifest MedEx, California’s largest nonprofit health information network, analysis of the impact of COVID-19 on healthcare utilization in California in 2020. The following is a summary of key findings of the report, based on an analysis of a longitudinal cohort of just over 4 million Californians, about 10% of the state’s population.

  • In addition to the many people who have experienced COVID-19 directly, the disease has also disrupted medical care for Californians.

  • Between March and mid-April 2020, ambulatory visit volumes across the state fell by more than 50%. Although visits quickly rebounded, volumes in the second half of the year remained about 20% below baseline levels.

  • Ambulatory visit declines for children (36%) and adolescents (25%) were substantially greater than for adults. Although some of this differential may be due to fewer respiratory infections, it is cause for concern.

  • Total medical claims volumes fell slightly more for Medi-Cal patients (21%) than for commercially insured patients, who experienced a 19% decline.

  • The volume of preventive services, such as mammography, colorectal cancer screening, and cervical cancer screening, fell 20% – 41% in 2020. It will be important to catch up quickly on these screening services and monitor whether cancers are diagnosed at later stages across the next few years.

  • In contrast, volumes for other services, such as hip arthroplasty and PET scans, were down only modestly for the year.

Abstract Lines

Ambulatory Visit Volumes Decreased During COVID-19

At the outset of the pandemic, health care leaders were concerned that COVID-19 would lead to care avoidance. Chart 1 shows that such concerns were well founded as volumes for both in-person and telemedicine care in California remained below the 2019 baseline throughout 2020. Ambulatory visit volumes across 2019 (depicted by the red line) were relatively constant across the year. Volumes then fell steeply beginning in late March 2020, declining to a low of 50% below pre-pandemic levels. Beginning in April 2020, visits stabilized and then rebounded to a level about 20% below 2019 levels.

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