CHANG AND HUANG RESPOND

Abstract

In our April 2004 article, we reported significant reductions in the utilization of medical services in Taiwan at the peak of the severe acute respiratory syndrome (SARS) epidemic. Our results suggested that the fear of SARS significantly influenced people’s utilization patterns and compromised their access to care. Ichikawa’s observation of apparent reductions in tuberculosis (TB) notifications in Hong Kong during the SARS epidemic in April and May of 2003 provide further evidence supporting this conclusion. More important, Ichikawa’s finding raises an interesting question: How did the fear of SARS influence the health care utilization of people with different types of diseases? In medicine, it is common to categorize diseases as acute or chronic. Within each category, diseases can be minor, progressive, or life threatening. Apart from TB, our preliminary analyses found that SARS affected ambulatory care utilization differently depending on the disease. The largest reductions in utilization were observed for minor acute diseases, such as acute respiratory tract infections, and modest reductions were found for chronic diseases that presented no immediate danger, such as diabetes. We found no change in utilization of medical services for life-threatening diseases, such as end-stage renal disease. One plausible explanation is that, faced with the terrifying risk of SARS infection, patients with minor acute ailments may have been more willing to forgo both necessary and unnecessary ambulatory care than patients with life-threatening diseases. Whereas patients with end-stage renal disease require regular kidney dialysis, patients with diabetes, a stable chronic disease, could easily put off their regular physician visits by asking for long-term prescriptions that allowed them to obtain 3 months’ worth of medication at a time. Thus we found considerably larger utilization reductions for patients with diabetes than for patients with life-threatening diseases. These findings reinforce the need for a thorough and systematic framework for evaluating the impacts of SARS on the general population. Because different diseases have different characteristics, hindered detection or treatment of diseases owing to the fear of SARS may result in different levels of health consequences for different members of the population. It is important to identify not only the overall effects of the fear of SARS on various services and diseases but also the smaller effects of the epidemic on people with different educational backgrounds, socioeconomic statuses, and health statuses. Future research can help advance our knowledge in this regard. A better understanding of the health impacts of the SARS epidemic can help public health agencies prevent avoidable health consequences and allocate resources more efficiently.