Section 1.1 The Consumption of Healthcare Services

COVID-19 infections drive individuals to seek various healthcare services — including doctor visits, emergency room (ER) visits, and hospital admissions — particularly during the acute phase. However, what happens once that phase concludes? Emerging data indicates that COVID-19 effectively resets the healthcare consumption baseline — leading to increased healthcare usage not just in the short term but extending for weeks, months, and even years afterward.

The challenge in the U.S. is that without a cohesive healthcare system, it becomes difficult to accurately assess healthcare usage before and after a COVID-19 infection. The one notable exception is the Veterans Health Administration (VA), which represents a fully socialized healthcare model in the U.S.

A significant study conducted by Paul Hebert and colleagues at VA Puget Sound, published in JAMA Network Open, sheds light on how much healthcare is consumed before and after a COVID-19 infection.

Source: Hebert et al. JAMA Network Open 2024.

Analyzing the Study's Methodology

Before sharing the findings, it’s important to acknowledge the complexities of this study. Patients with pre-existing health conditions tend to use more healthcare services and are at a greater risk of COVID-19, necessitating a robust control group for comparison.

Researchers identified 202,803 Veterans who had contracted COVID-19 and matched them with an equal number of uninfected Veterans, ensuring that variables such as sex, state of residence, immunosuppressive medication use, and vaccination status were consistent. They further matched participants based on a propensity score reflecting the likelihood of COVID-19 infection, derived from 37 different factors, including demographics, comorbidities, and healthcare utilization.

Ultimately, the study created a “digital twin” approach, where each infected participant was paired with a closely matched uninfected counterpart. This allowed researchers to determine the transition point for the control group based on when their counterpart became infected.

While not a randomized trial, the groups were well matched in terms of age, BMI, and smoking status, enhancing the validity of the results.

Section 1.2 Observing Healthcare Utilization Trends

Prior to infection, both groups exhibited similar, low levels of emergency care usage. However, post-infection, the COVID-19 group displayed a significant spike in ER visits, as expected. Notably, while ER visit rates decreased relatively quickly, they remained slightly elevated compared to the control group.

Source: Hebert et al. JAMA Network Open 2024.

The study becomes particularly intriguing when examining primary care visits. Initially, both groups had similar utilization rates. However, following infection, there was a substantial increase in the COVID group, which persisted even 52 weeks later, translating to roughly two additional primary care visits annually for each COVID-19 infection.

Source: Hebert et al. JAMA Network Open 2024.

Interestingly, mental health service usage also spiked at the time of infection, suggesting profound implications on mental health as well.

Source: Hebert et al. JAMA Network Open 2024.

The study concluded that on average, COVID-19 patients had approximately nine additional healthcare visits in the year following their infection compared to well-matched controls. This significant increase in healthcare utilization raises concerns, as resources are finite.

Addressing the Healthcare Burden

However, subgroup analyses revealed that the rise in healthcare consumption post-infection was less pronounced among younger individuals and during later pandemic waves. Additionally, vaccinated individuals experienced a smaller increase in healthcare utilization, highlighting an area where interventions can be made.

This research underscores the often overlooked consequences of the pandemic — factors that are challenging to quantify yet are felt in everyday medical practice. Physicians are now busier and facing greater stress, managing patients who are increasingly unwell. As we navigate the aftermath of this global crisis, we must confront the new challenges that have emerged.