Changes in Healthcare Utilization, Spending, and Perceived Health during COVID–19: A Longitudinal Study from Singapore

37 Pages Posted: 11 Aug 2020

See all articles by SangNam Ahn

SangNam Ahn

University of Memphis - School of Public Health

Seonghoon Kim

Singapore Management University

Kanghyock Koh

Korea University - Department of Economics

Multiple version iconThere are 2 versions of this paper

Date Written: August 7, 2020

Abstract

Importance: The outbreak of the novel coronavirus (COVID–19) has challenged the capacity of healthcare systems around the world and can potentially compromise healthcare utilization and health outcomes among non-COVID–19 patients. However, the empirical evidence regarding changes in healthcare utilization, healthcare spending, and health status among non-COVID–19 patients is limited.

Objective: To examine the associations of the COVID-19 pandemic with healthcare utilization, out-of-pocket medical costs, and perceived health status in Singapore.

Design: A retrospective observational study using a difference-in-differences method that examines changes in healthcare utilization, healthcare spending, and perceived health status before and during the outbreak of COVID-19 of the same individuals using monthly individual-level panel survey data.

Setting: Singapore between June 2018 and June 2020.

Participants: Singaporeans aged 50–70 (N=7,569; January 2020).

Exposures: Outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in January 2020 in Singapore.

Main Outcomes and Measures: Healthcare utilization, diagnosis of chronic health conditions, out-of-pocket medical costs (total and by medical service categories), self-reported measures of overall health status, sleep quality, and depressive symptoms.

Results: Of 7,569 sample respondents in the January 2020, 53% are female, and 87% are ethnic Chinese. Their average age was 63.2. Between January and April 2020, COVID-19 was associated with a decrease in doctor visits by 9.3 percentage points (31% reduction from 29.8%; 95% Confidence Interval (CI), -11% to -8%). It was also associated with a decrease in out-of-pocket medical spending by S$46.5 (23% reduction from S$198 in January 2020; 95% CI, -S$74.3 to -S$18.7), mostly driven by reductions in inpatient and outpatient care, and a decrease in the probability of any diagnosis of chronic conditions by 2.7 percentage points (19% reduction from 13.9%; 95% CI, -4% to -2%). Although there were little changes in self-reported health status and sleep quality, COVID–19 was associated with an increase in depressive symptoms by 2.8 percentage points (4% reduction from 71%; 95% CI, 1.1% to 4%).

Conclusions and Relevance: It is imperative to monitor COVID–19’s long-term health effects among non-COVID–19 patients since our findings indicated delayed healthcare and worsened mental health related to the outbreak.

Keywords: COVID–19, pandemic, healthcare utilization, healthcare spending, self-reported health status, mental health

Suggested Citation

Ahn, SangNam and Kim, Seonghoon and Koh, Kanghyock, Changes in Healthcare Utilization, Spending, and Perceived Health during COVID–19: A Longitudinal Study from Singapore (August 7, 2020). Available at SSRN: https://ssrn.com/abstract=3669090 or http://dx.doi.org/10.2139/ssrn.3669090

SangNam Ahn

University of Memphis - School of Public Health ( email )

Memphis, TN
United States

Seonghoon Kim

Singapore Management University ( email )

90 Stamford Road
178903
Singapore
6568085465 (Phone)

Kanghyock Koh (Contact Author)

Korea University - Department of Economics ( email )

145 Anam-ro Seongbuk-gu
Seoul, Seoul 02841
Korea, Republic of (South Korea)

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