September 16, 2020

Experts predicted a sharp rebound in preventive care. Why hasn't it materialized?

Daily Briefing

    Americans significantly scaled back their preventive care when the novel coronavirus first struck, and the trend hasn't fully reversed since then—suggesting that patients may never make up for deferred care, according to a new report released by the Health Care Cost Institute (HCCI) on Wednesday.

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    For the report, HCCI examined preventive care use during America's coronavirus epidemic by comparing health claims data across 18 states from the first six months of 2020 with health claims data from 2019. Specifically, the researchers analyzed 94 million claims from 20 million patients during the first six months of 2020 and 184 million claims from 30 million patients in 2019.

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    The researchers focused their analysis on a select number of preventive health services, including childhood immunizations, colonoscopies, Pap smears, and mammograms.

    Findings

    According to the researchers, the volumes of most of the preventive care health services they examined declined dramatically from mid-March through mid-April, when compared with 2019 claims data—and as of late June, the use of many preventive services was still down by one-third. 

    For example, the researchers found that the number of claims for colonoscopies dropped nearly 90% at one point during mid-April when compared with 2019—and as of June, while colonoscopy claims had rebounded, they were still about 30% lower than last year's levels.

    Similarly, the researchers found that childhood immunizations in aggregate declined by 60% in April when compared with 2019 levels, and by June were still 30% lower than in 2019. Most notably, the researchers found that the measles vaccination rate remained 36% lower than 2019 levels by the end of June—a potentially troubling finding considering the United States last year nearly lost its measles elimination status.

    According to the researchers, the use of mammograms and Pap smears also declined, dropping by almost 80% in April when compared with 2019, and, as of June, remained 25% lower than 2019 levels. And insertions of IUDs, which are among the most effective forms of birth control, dropped at similar rates to other preventive care services, the New York Times' "The Upshot" reports.

    However, there were some exceptions to the trend. For instance, PSA tests, which are used to screen for prostate cancer, declined by only around 20%, and have rebounded to nearly the same levels as 2019, according to the report.

    Discussion

    According to "The Upshot," health care experts had predicted that, after preventive care dipped at the start of the pandemic, those services would experience a sharp rebound—leading to higher-than-average demand as patients made up for deferred care.

    However, the latest data suggests the predicted demand hasn't materialized, and even though preventive visits seem to be "inching toward normal levels," "The Upshot" reports, they are not yet exceeding the volume of previous years.  

    "The pandemic has not played out like any of us would have hoped, and we don't see that [rebound] pattern," said Ateev Mehrotra, associate professor of health policy at Harvard Medical School who in his own research found doctor office visits have not recovered since the epidemic struck. "Now it seems that the vast majority of that deferred care will never come back."

    According to health care experts, it could take years to understand the impact of deferred preventive care, such as whether it leads to an increase in colon cancers that would otherwise have been detected by colonoscopies.

    Eric Schneider, SVP for research at the Commonwealth Fund, said, "Some of these are time-sensitive services. Are we going to see a little baby boomlet because women were unable to get family planning services? These are services where you'd want to see a rebound above the baseline, to get a sense the backlog was clearing. We don't see that, and it's a concern."

    However, according to "The Upshot," one factor in the apparently low use of preventive care in June could be the lag between when health providers submit their claims and when health insurers process them. As such, reported preventive care volumes could surge in the coming months as insurers process more claims, "The Upshot" reports (Kliff, "The Upshot," New York Times, 9/11; Weixel, The Hill, 9/11; HCCI report, 9/9).

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