Patient Behavior During the COVID-19 Pandemic and Impacts on Medical Institution Revenue

We analyzed patient behavior before and during the COVID-19 pandemic (from February 2019 to October 2021) using a combination of data sources, including claims data from the national health insurance and over-75s healthcare insurance systems, and outpatient and inpatient data (so-called “DPC data”) from a large, nationally distributed group of Japanese hospitals. We identified that COVID-19-related hygiene measures and behavioral changes significantly reduced medical consultations and hospitalizations for non-COVID-19 infectious diseases. Medical consultations relating to chronic diseases, such as hypertension, diabetes, back pain, and knee pain, greatly decreased. The prolonged interval of drug prescriptions appears to be a major factor behind the decrease in follow-up visits. In addition, medical consultations at acute care hospitals for minor illnesses and casual use of ambulance services also greatly decreased. It also appears possible that certain medical investigations and interventions, such as for cancer and angina pectoris, were postponed or cancelled. The significant changes that we identified in patient behavior during the COVID-19 pandemic, namely a major reduction in non-COVID-19 patients’ propensity to seek medical care, present major challenges to the management of medical institutions in Japan. This is because the vast majority of hospitals and clinics operate on a fee-for-service basis—or a prospective, per-diem basis in the case of inpatient services (except for surgical procedures, which are fee-for-service) at hospitals operating under the “DPC/PDPS” system—and therefore rely on long-term hospitalizations and frequent consultations for revenue. With Japan’s population continuing to decline rapidly, it is essential to construct a medical care provision system that does not depend on these factors. To achieve this, consolidation of medical institutions, a review of the remuneration system, and the introduction of medical care quality evaluations will be inevitable. In addition to improving the transparency of medical services through the use of DPC and health insurance claims data, it is also necessary to improve transparency and verify the effectiveness of the various COVID-19 subsidies received by medical institutions, such as through the mandated electronic disclosure of business reports. All medical institutions should have to prepare and publish annual financial statements under accounting standards equivalent to those imposed on companies.