Department of Socail Management and Socail Policy, School of Social Development and Public Policy, Fudan University, Shanghai, China.
Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China.
BMJ Glob Health. 2020 Nov;5(11). doi: 10.1136/bmjgh-2020-003421.
The COVID-19 pandemic caused a healthcare crisis in China and continues to wreak havoc across the world. This paper evaluated COVID-19's impact on national and regional healthcare service utilisation and expenditure in China.
Using a big data approach, we collected data from 300 million bank card transactions to measure individual healthcare expenditure and utilisation in mainland China. Since the outbreak coincided with the 2020 Chinese Spring Festival holiday, a difference-in-difference (DID) method was employed to compare changes in healthcare utilisation before, during and after the Spring Festival in 2020 and 2019. We also tracked healthcare utilisation before, during and after the outbreak.
Healthcare utilisation declined overall, especially during the post-festival period in 2020. Total healthcare expenditure and utilisation declined by 37.8% and 40.8%, respectively, while per capita expenditure increased by 3.3%. In a subgroup analysis, we found that the outbreak had a greater impact on healthcare utilisation in cities at higher risk of COVID-19, with stricter lockdown measures and those located in the western region. The DID results suggest that, compared with low-risk cities, the pandemic induced a 14.8%, 26.4% and 27.5% reduction in total healthcare expenditure in medium-risk and high-risk cities, and in cities located in Hubei province during the post-festival period in 2020 relative to 2019, an 8.6%, 15.9% and 24.4% reduction in utilisation services; and a 7.3% and 18.4% reduction in per capita expenditure in medium-risk and high-risk cities, respectively. By the last week of April 2020, as the outbreak came under control, healthcare utilisation gradually recovered, but only to 79.9%-89.3% of its pre-outbreak levels.
The COVID-19 pandemic had a significantly negative effect on healthcare utilisation in China, evident by a dramatic decline in healthcare expenditure. While the utilisation level has gradually increased post-outbreak, it has yet to return to normal levels.
COVID-19 大流行在中国引发了医疗危机，并继续在全球范围内造成严重破坏。本文评估了 COVID-19 对中国国家和地区医疗服务利用和支出的影响。
使用大数据方法，我们从 3 亿张银行卡交易中收集数据，以衡量中国大陆个人的医疗支出和利用情况。由于疫情爆发恰逢 2020 年中国春节假期，因此采用了差分法（DID）来比较 2020 年和 2019 年春节前后医疗利用的变化。我们还跟踪了疫情爆发前后的医疗利用情况。
总体而言，医疗利用下降，尤其是 2020 年春节后。总医疗支出和利用率分别下降了 37.8%和 40.8%，而人均支出增加了 3.3%。在亚组分析中，我们发现疫情对 COVID-19 风险较高城市的医疗利用影响更大，这些城市的封锁措施更严格，位于西部地区。DID 结果表明，与低风险城市相比，疫情导致中风险和高风险城市的总医疗支出在节后期间分别减少了 14.8%、26.4%和 27.5%，而在 2020 年相对 2019 年，位于中风险和高风险城市的利用服务分别减少了 8.6%、15.9%和 24.4%；中风险和高风险城市的人均支出分别减少了 7.3%和 18.4%。到 2020 年 4 月最后一周，随着疫情得到控制，医疗利用逐渐恢复，但仅恢复到疫情前的 79.9%-89.3%水平。
COVID-19 大流行对中国的医疗利用产生了显著的负面影响，表现为医疗支出的急剧下降。虽然疫情后利用率逐渐增加，但尚未恢复到正常水平。
