Infectious disease
Does COVID-19 raise healthcare use and costs for months afterwards?
Open access · cc by · source: Europe PMC
After a COVID-19 diagnosis, adults kept using more healthcare and costing more each month for at least six months than they had before infection, while children returned close to their previous level.
Study at a glance
- Design
- Cohort — Retrospective within-patient before-after cohort using US insurance claims: monthly visits and costs in the 6 months before versus 6 months after a lab-confirmed COVID-19 diagnosis (February-October 2020), modelled with linear regression and monthly lead/lag terms, excluding pulmonary encounters.
- N
- N=250514 · 250,514 patients (from 3,006,168 medical claims) with six months of records before and after diagnosis; commercially insured, Medicare, Medicaid and uninsured patients.
- Population
- US patients of all ages with a lab-confirmed COVID-19 diagnosis between February and October 1, 2020, in a national claims database covering commercial, Medicare, Medicaid and HRSA-uninsured payers.
- Outcome
- Monthly healthcare visits and medical expenditures across ten service categories (inpatient, emergency, telemedicine, surgery, cardiology and others), overall and by age group.
Structured fields used in claim comparison tables when every cited study has a complete layer.
Key findings
On average a COVID-19 diagnosis was associated with 0.7269 extra visits (roughly three-quarters of a visit) and $223.59 extra spending per month over the following six months, driven mainly by inpatient, emergency and surgical care, with smaller rises in telemedicine and cardiology. Use peaked in the diagnosis month and declined but did not return to pre-diagnosis levels; excess visits fell from 0.499 in the second month to 0.158 in the sixth. Children's excess use and costs essentially disappeared by month six, whereas all adult groups stayed above baseline, with people aged 45-64 having the largest excess costs.
Methodology
The researchers used de-identified US insurance claims to follow 250,514 people with lab-confirmed COVID-19 diagnosed between February and October 2020, comparing each person's monthly healthcare use and spending in the six months before diagnosis with the six months after. They grouped services into ten categories such as inpatient, emergency, telemedicine and cardiology, deliberately leaving out lung-related visits, and adjusted for age, sex, insurance type and local socio-economic factors. Month-by-month models then estimated 'excess' use and cost by pairing each post-diagnosis month with its matching pre-diagnosis month.
Limitations
There was no comparison group of people without COVID-19, so the authors stress the results are descriptive and not causal; rising use could reflect other health problems or pandemic-era changes in care. The claims come from providers, so some care is missing and estimates are lower bounds, and mortality was not recorded, so likely deaths were excluded, possibly biasing older groups. Lung-related visits were deliberately excluded, the sample was diagnosed early in the pandemic before vaccines, and the study cannot tell whether extra care was for long-COVID symptoms or pre-existing conditions.
How this study connects
Role on claims
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