Missed Vaccines, Skipped Colonoscopies: Preventive Care Plummets

Missed Vaccines, Skipped Colonoscopies: Preventive Care Plummets

When the coronavirus pandemic broke out, Americans scaled back their health care plans significantly, and there is little evidence that these postponed care will be made good.

Vaccinations fell nearly 60 percent in April, and almost no colonoscopes have been made, according to new data from the nonprofit Health Care Cost Institute.

The data, drawn from millions of health insurance claims, shows a consistent pattern of whether it's prostate screenings or contraception: preventive care dropped drastically this spring and hadn't recovered to normal levels by the end of June. Many types of such treatments were still declining a third earlier this summer, as the latest data available shows, as Americans continued to be cautious about visiting hospitals and doctor's offices.

"What I noticed was how similar all the patterns were," said Niall Brennan, the institute's president. "Some services had deeper ground than others, but the slope of the lines was pretty similar regardless of which service you selected."

Americans continued to seek care they couldn't avoid – for example, hospital admissions at birth remained stable – but avoided care they could postpone. More invasive preventive procedures such as mammograms and colonoscopies showed the greatest decline.

Colonoscopies, which are usually used for the early detection of colorectal cancer, fell 88 percent in mid-April and were 33 percent below normal at the end of June. Mammograms, which fell 77 percent at the height of the pandemic, are still down 23 percent.

The numbers could change slightly as insurers continue to process health care providers' claims. A small time lag probably explains why the data currently shows a fall in births in June. As more data become available, prevention services have seen more recent increases.

The data shows how the pandemic has expanded from intensive care units caring for coronavirus patients to general practitioners and pediatricians whose practices have been impacted by lower patient demand.

Critical childhood vaccinations against hepatitis, measles, whooping cough and other diseases also fell significantly, a trend that worried pediatricians earlier in the pandemic. Particularly worrying was that measles vaccinations fell 73 percent in mid-April and were still 36 percent lower at the end of June.

Measles was on the rise in the United States even before this year, coinciding with the growing strength of the anti-vaccination movement. The fact that fewer children were vaccinated due to coronavirus fears could make the trend worse.

One preventive service, however, remained relatively stable during the pandemic: pregnancy-related ultrasounds. These fell slightly in March and April, but never fell more than 20 percent below their 2019 level. The use of IUDs, one of the most effective methods of contraception, decreased, as with other preventive measures, which increased the possibility of pregnancies in the coming months elevated.

When the pandemic started, some experts predicted that a decline in supply would be followed by a boom in demand. Doctors' offices may see more than normal visits as patients make up for postponed care.

Six months after the pandemic began, this did not happen. Visits to the doctor seem to be moving towards normal values, but do not exceed the volume of recent years. Even if demand increases in the coming months, health care providers may struggle to meet them as social distancing protocols limit their capacity.

"The pandemic has not played out as any of us would have hoped, and we are not seeing this pattern," said Ateev Mehrotra, associate professor of health policy at Harvard Medical School. "Now it seems that the vast majority of this deferred care will never return."

Dr. Mehrotra recently examined the trends in doctor visits using another dataset. His work also shows a significant decrease in doctor visits, followed by an incomplete rebound through mid-August.

While doctor visits for adults are much closer to normal, those for children a month ago were 26 percent lower than normal.

Health researchers say it will take years to understand how deferred screening could affect Americans' health outcomes. For example, will fewer colonoscopies lead to more cases of advanced colon cancer? Will there be more communicable disease outbreaks due to lower vaccination rates?

"Some of these are time-sensitive services," said Eric Schneider, senior vice president of research for the Commonwealth Fund. “Are we going to see a little baby boom because women couldn't get family planning services? These are services that aim to show a recovery above baseline to get a sense that the backlog has been cleared. We don't see that and it's a problem. "


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