Coronavirus Disease 2019, Universal Health Coverage, and Ambulatory Care in 2020.

Measures taken to keep the coronavirus disease 2019 (COVID-19)-related mortality and morbidity rate low have led to a decline in ambulatory care utilization.1–3 Despite the increasing use of telemedicine, ambulatory care utilization did not reach prepandemic levels in 20202,3 and the forgone or postponed care was salient for less privileged populations.3 Hence, we compared ambulatory care visits in 2020 from England and Germany to the United States to contribute to the discussion on the need for universal health coverage.4–10

Figure 1 shows monthly changes in ambulatory care utilization adjusted for the prepandemic seasonal variation and weekly COVID-19 deaths per 100,000 population for England, Germany, and the United States in 2020. Outpatient utilization dropped to the lowest level in April (decreased by 24%, 39%, and 54% of the prepandemic level in Germany, England, and United States, respectively), when the strictest measures were applied in 3 countries. In Germany, outpatient utilization bounced back to prepandemic level much faster than in England and the United States in June 2020 and remained stable despite the surge in deaths through the end of 2020, whereas it stabilized at around 8% below the prepandemic level in the United States. On average, ambulatory care utilizations in England, Germany, and the United States were respectively 14%, 4%, and 16% lower in 2020 than the baseline. The decline in ambulatory care utilization in Germany was statistically significantly less than that of England (P=0.001), and the United States (P=0.002); changes in ambulatory care utilization in England and the United States were not statistically significantly different (P=0.48). Although both England and Germany have universal health care systems, pattern of changes in ambulatory care utilization in England followed the pattern in the United States more closely. Therefore, in addition to universal health coverage, pandemic management is essential to minimize disruptions in health care utilization to avoid further public health problems.

FIGURE 1

Percent change in ambulatory care utilization from baseline, adjusted for seasonality, and coronavirus disease 2019 (COVID-19) deaths per 100,000 population for England, Germany, and the United States in 2020. Data are presented as a percentage change in the number of visits in a given month from baseline month (January 2020), adjusted for prepandemic seasonality. Prepandemic seasonal adjustments are made based on 2019 utilizations in England and Germany and 2016–2019 utilizations (equally weighted across the years) for the United States. Data sources are listed in the Supplemental Digital Content 1 (http://links.lww.com/MLR/C446).

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