Trends in Healthcare Access in Japan during the First Wave of the COVID-19 Pandemic, up to June 2020.

Koji Makiyama,Yumi Kawamura,Akifumi Eguchi,Stuart Gilmour,Yuta Tanoue,Shuhei Nomura,Daisuke Yoneoka,Shinya Uryu,Kentaro Matsuura,Shoi Shi,Takayuki Kawashima,Masahiro Hashizume,Haruka Sakamoto

doi:10.3390/ijerph18063271

Abstract

We evaluated the impact of the new coronavirus disease (COVID-19) on healthcare access in Japan in terms of the number of outpatients and hospitalized patients as well as the length of hospital stays, during the first wave of the pandemic, up to June 2020. This observational study evaluated the monthly average number of outpatients per day at hospitals, the average number of hospitalized patients per day, and the average length of hospital stays per patient, from December 2010 to June 2020, using the hospital reports data, which are open aggregated data on the utilization of hospitals from the Ministry of Health, Labour and Welfare. These numbers were compared with those from the same period of previous years, using a quasi-Poisson regression model. We found a nationwide decrease in the number of outpatients in general hospitals and hospitalized patients, particularly in long-term care beds in Japan, as well as the excess length of hospital stays among psychiatric care patients during the first wave of the COVID-19. This limited access to healthcare demonstrated the importance of the long-term health monitoring of vulnerable populations and the need for urgent management support to healthcare facilities in preparation for possible prolonged pandemics in the future.

Highlights

The new coronavirus disease (COVID-19) placed an additional burden on health systems, leading to strain on all resources, including intensive care unit (ICU) beds, human resources, and access to adequate personal protective equipment (PPE) [1]
Long-term care beds are sub-grouped into those covered by long-term care insurance (LTCI) (f) and those covered by medical insurance, and only the former data are available
Since January 2020, there have been no months in either general or psychiatric hospitals in which the observed number of outpatient visits was above the 95% upper bound of the expected values

Summary

Introduction

The new coronavirus disease (COVID-19) placed an additional burden on health systems, leading to strain on all resources, including intensive care unit (ICU) beds, human resources, and access to adequate personal protective equipment (PPE) [1]. As such, interrupted access to quality healthcare services due to this unprecedented event has been acknowledged in the worstaffected countries [3,4,5]. As an extreme consequence, increased mortality attributable to the reduced or delayed utilization of routine and emergency healthcare services has been observed in some countries [6,7,8]. In the United States, there is an excess of deaths compared to previous years from non-respiratory diseases, such as cardiovascular disease, diabetes, and Alzheimer’s disease, due to delayed emergency and routine care [9,10,11]. Japan has avoided an explosive surge of COVID-19 infections to date, and has yet to experience as serious a mortality burden as the United States and Europe [12]

Methods

Results

Discussion

Conclusion