Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania.
JAMA Health Forum. 2021 Dec 30;2(12):e214299. doi: 10.1001/jamahealthforum.2021.4299. eCollection 2021 Dec.
Evidence suggests that the COVID-19 pandemic has had a negative association with medical care access. As prior studies mainly focused on the initial stage of the COVID-19 pandemic, less is known about how trends in forgone medical care changed over time.
To examine trends in and reasons for forgone medical care among Medicare beneficiaries during the COVID-19 pandemic.
This cross-sectional study analyzed Medicare beneficiaries using data from 3 waves of survey data from the Medicare Current Beneficiary Survey COVID-19 Supplement (Summer 2020, Fall 2020, and Winter 2021). Data analyses were conducted between July and August 2021.
Date of interview.
Self-reported forgone medical care because of COVID-19.
A total of 23 058 Medicare beneficiaries were included (13 005 women [56.4%]; 10 445 [45.3%] 75 years old and older). The survey response rates for each wave were 72.6%, 78.95, and 79.6%, respectively. The rates of reported forgone medical care because of COVID-19 decreased from the week of June 7, 2020, to the week of April 4 to 25, 2021, but the largest difference in the rates was found between June 7 and July 12, 2020 (22.4% to 15.9%). Physician-driven factors accounted for about 70% of the forgone medical care. The proportion of those who reported forgoing medical care because of physician-driven factors tended to decrease from 66.2% in the week of July 7, 2020, to 44.7% in the weeks of April 4 to 25, 2021. The likelihood of forgone medical care was 4 percentage points (95% CI, 0.03-0.05) higher among those who reported feeling more stressed or anxious than those who did not, 3 percentage points (95% CI, 0.01-0.04) higher among those who reported feeling more lonely or sad than those who did not, and 3 percentage points (95% CI, 0.01-0.04) higher among those who reported feeling less socially connected than those who did not.
The results of this cross-sectional survey study suggest that the COVID-19 pandemic may exacerbate existing barriers to care and lead Medicare beneficiaries to delay needed care. Policy makers must continue to identify effective means of meeting the forgone care backlog and maintaining continuity of care, especially for those with mental health problems.
有证据表明，COVID-19 大流行对医疗保健的可及性产生了负面影响。由于先前的研究主要集中在 COVID-19 大流行的初始阶段，因此对于医疗保健的放弃趋势随时间的变化了解较少。
检查 COVID-19 大流行期间 Medicare 受助人放弃医疗的趋势和原因。
设计、地点和参与者：这项横断面研究使用 Medicare 当前受益人调查 COVID-19 补充调查（2020 年夏季、2020 年秋季和 2021 年冬季）的 3 波调查数据，对 Medicare 受助人进行了分析。数据分析于 2021 年 7 月至 8 月之间进行。
采访日期。
因 COVID-19 而放弃的自我报告医疗。
共纳入 23058 名 Medicare 受助人（13005 名女性[56.4%]；10445 名[45.3%]年龄在 75 岁及以上）。每个波次的调查回复率分别为 72.6%、78.95%和 79.6%。因 COVID-19 而报告的放弃医疗的比率从 2020 年 6 月 7 日的那一周下降到 2021 年 4 月 4 日至 25 日的那一周，但在 2020 年 6 月 7 日至 7 月 12 日之间的比率差异最大（22.4%至 15.9%）。医生驱动的因素约占放弃医疗的 70%。自 2020 年 7 月 7 日那一周以来，报告因医生驱动因素而放弃医疗的比例从 66.2%下降到 2021 年 4 月 4 日至 25 日那一周的 44.7%。与未感到压力或焦虑的人相比，感到压力或焦虑的人放弃医疗的可能性高 4 个百分点（95%CI，0.03-0.05），与未感到孤独或悲伤的人相比，感到孤独或悲伤的人高 3 个百分点（95%CI，0.01-0.04），与未感到社会联系较少的人相比，感到社会联系较少的人高 3 个百分点（95%CI，0.01-0.04）。
这项横断面调查研究的结果表明，COVID-19 大流行可能会加剧现有的护理障碍，并导致 Medicare 受助人延迟所需的护理。政策制定者必须继续寻找有效的方法来解决积压的放弃护理问题，并保持护理的连续性，特别是对那些有心理健康问题的人。
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