Lower healthcare utilization amid COVID-19 foreshadows looming health crisis in PH

The coronavirus disease 2019 (COVID-19) pandemic has disrupted healthcare utilization in the Philippines, leading to lower rates of admission and procedures for certain types of disease, according to a recent study.

“The Philippines has the highest cumulative COVID-19 cases and deaths in the Western Pacific. To explore the broader health impacts of the pandemic, we assessed the magnitude and duration of changes in hospital admissions for 12 high-burden diseases and the utilization of five common procedures by lockdown stringency, hospital level, and equity in patient access,” the researchers said.

“COVID-19’s prolonged impact on the utilization of hospital services in the Philippines suggests a looming public health crisis in countries with frail health systems,” they added.

National social health insurance data, filed by 1,295 hospitals in 2019 and 2020, showed that overall, total admissions for 12 high-burden diseases dropped by 54 percent in 2020 under the COVID-19 pandemic. These diseases included asthma, cancer, dengue, stroke, diabetes, and chronic kidney disease, among others, all of which saw a decrease in admission in 2020. [Lancet Reg Health West Pac 2021;doi:10.1016/j.lanwpc.2021.100310]

Dengue admissions, in particular, saw the greatest decline in 2020, dropping 69 percent relative to 2019 figures. This was followed by asthma (66-percent decline), pneumonia (65 percent decline), and chronic obstructive pulmonary disease (58-percent decline).

Similarly, the national claims data focused on five common procedures: cataract surgery, chemotherapy, caesarean section, haemodialysis, and vaginal birth. In aggregate, there was a small 13-percent increase in procedure utilization in 2020 vs 2019. Such an increase was driven mainly by haemodialysis, which showed large growths in the third quarter of 2020, eventually eclipsing its 2019 utilization rate by 25 percent.

In comparison, diseases and procedures in urgent and nonelective care, such as cancer, caesarean sections, stroke, and chemotherapy, saw modest declines in utilization.

Moreover, the researchers found that during both the strictest (April to May 2020) and most relaxed (May to December 2020) lockdown periods, the decline in healthcare utilization was three times greater among the poor (21 percent and 39 percent, respectively) than in rich counterparts (17 percent and 12 percent, respectively).

“Taking our results as a whole, we present an analysis that can inform a whole-of-system strategy,” the researchers said. “To our knowledge, there has been no low-and-middle income country in Southeast Asia with similar research on a national scale focusing on the country’s top diseases and looking across lockdown policies over time, hospitals, and equity in patient access.”

The findings point to a possible health crisis for the Philippines and other countries with weak healthcare systems, they added.

“Foregone care for infectious and noncommunicable diseases may lead to long-term increases premature mortality and morbidity with expensive and impoverishing complications. A whole-of-health perspective considering all conditions and procedures, service delivery networks, and access for the most vulnerable through epidemic waves and lockdown restrictions is critical,” the researchers said.