Changes in inpatient healthcare utilization at public hospitals during the Covid-19 pandemic

Objective: Public hospitals play an important role in reducing health inequality among socially marginalized groups and local communities. The objective of this study was to investigate changes in healthcare utilization at public hospitals during the COVID-19 pandemic in Korea.Methods: The unit of analysis was public hospitals. This study adopted a retrospective longitudinal study design and used inpatient health insurance claim data from January 1, 2019 to December 31, 2020. In total, 206 public hospitals were analyzed. For statistical analysis, a generalized linear model using the number of health insurance claims was constructed.Results: The total number of patients who received COVID-19-related care was 44,949, with a length of stay (LOS) of 657,717 days. After controlling for hospital covariates, healthcare utilization at public hospitals decreased by 22.5% (relative risk [RR], 0.775; p=0.029) and 16.8% (RR, 0.832; p=0.045) for the actual number and total LOS of national health insurance patients, respectively. For beneficiaries of the Medical Aid program, the actual number and total LOS were reduced by 29.6% (RR, 0.704; p=0.001) and 35.8% (RR, 0.642; p=0.001), respectively. Interestingly, most of this reduction occurred at public hospitals providing general healthcare services.Conclusion: Despite significant changes in healthcare utilization, public hospitals played a critical role in providing healthcare regarding COVID-19. Healthcare policymakers need to pay more attention to the role of public hospitals in the next infectious disease pandemic.