Predicting the utilization of healthcare services during COVID-19 - forecasting models based on routine data

Background

The COVID-19 pandemic has significantly impacted global healthcare systems through the prioritisation of COVID-19 cases and the reallocation of resources, leading, for example, to a postponement of elective procedures. This study quantifies the impact of the COVID-19 pandemic on healthcare utilization in 2020 and 2021.

Methods

Forecasting models were trained using data from the pre-pandemic years 2013 to 2019. The most suitable model was used to predict a trend in healthcare utilization unaffected by the pandemic in the two pandemic years. Deviations between observed and predicted utilization were interpreted as the pandemic impact on healthcare.

Results

During the COVID-19 pandemic, all-cause hospitalizations declined across the first three waves. The first drop occurred in April 2020, with hospitalization rates falling to 1.7 times below expected pre-pandemic levels. A second drop began in November 2020, reaching 1.4 times below expected levels by January 2021. Hospitalizations returned to pre-pandemic levels after strict lockdown measures eased. These declines affected elective procedures but also life-threatening conditions, such as myocardial infarctions (MI). In March and April 2020, admissions for these events were 1.29 times below expected levels. By July 2020, however, MI hospitalization increased, reaching 0.87 times higher than typical pre-pandemic rates.

Discussion

We investigate for the first time the impact of the pandemic on healthcare in Germany using modern forecasting methods showing delayed hospitalizations for acute conditions like MI. Findings highlight the need to protect vulnerable groups and underscore the importance of further research on long-term health impacts and improved public health responses.

Lay summary

The COVID-19 pandemic has significantly disrupted healthcare provision by prioritising COVID-19 cases over other conditions, leading to postponement of interventions and reduced care for serious problems such as myocardial infarctions (MI). This study examined healthcare utilization in Germany in 2020–2021 by comparing observed hospitalisations with predicted values based on pre-pandemic trends from 2013–2019. The results showed a sharp decline in hospitalisations during the first three pandemic waves. In April 2020, hospital admissions fell to almost half the expected level, with a second decline at the end of 2020. Normalisation only set in when the lockdown measures were lifted. Crucially, admissions for life-threatening conditions such as MI also fell temporarily, showing a time lag in hospital admissions. This analysis emphasises the importance of ensuring access to healthcare for critical illnesses, even in times of pandemic, to reduce negative health impacts and improve the resilience of healthcare in future crises.