Longitudinal analyses (2018-2022) of the COVID-19 impact on Swiss pediatric healthcare utilization

Abstract Background The impact of COVID-19 on healthcare utilization in the early pandemic is well documented. However, studies on changes in both primary and tertiary pediatric healthcare utilization that considered data beyond the first pandemic year is lacking. Methods National health insurance data (primary care) and pediatric emergency department data (tertiary care) from Jan. 2018 - June 2022 and on 0-18-year-olds were analyzed with interrupted time series. The first lockdown was used to differentiate between pre-pandemic and pandemic periods. Results Several healthcare services yielded significantly lower average utilization rates during the pandemic vs. the pre-pandemic period, particularly in the youngest age groups. In primary care, the relative utilization, compared to the pre-pandemic mean, dropped in regards to regular (0-5y: 0.760 [0.644-0.896]; 6-10y: 0.850 [0.742-0.974]), well-child (0-5y: 0.871 [0.765-0.992]), and urgent visits (0-5y: 0.638 [0.500-0.813]; 6-10y: 0.810 [0.665-0.985]), and for the vaccination against measles/mumps/rubella (MMR; 0-5y: 0.841 [0.729-0.971]). Similarly, in tertiary care, this pattern emerged for non-urgent (Zurich: 0.55 [0.482-0.627]; Geneva: 0.526 [0.435-0.636]; Ticino: 0.502 [0.436-0.578]) and urgent visits (Zurich: 0.573 [0.498-0.659]; Geneva: 0.487 [0.375-0.632]; Ticino: 0.676 [0.57-0.802]). The utilization rates of most services dropped markedly after the lockdown and recovered to some extent over the pandemic phase. However, no recovery was found for the MMR-vaccination. In primary care, higher average utilization rates during the pandemic were identified for telephone consultations (0-5y: 1.394 [1.218-1.594]; 6-10y: 1.547 [1.387-1.726]; 11-15y: 1.578 [1.430-1.741]; 16-18y: 1.831 [1.614-2.076]). Conclusions The pandemic’s effect on utilization seemed to have occurred temporarily, but it cannot be ruled out that some children have not fully caught up on preventative measures (well-child visits and MMR-vaccinations). Key messages • Pediatric healthcare utilization dropped considerably immediately after the lockdown, with the most pronounced decrease observed in the youngest children. • The heterogenous recovery over the pandemic period points to the necessity to continue to monitor utilization rates, catch-up visits, and vaccination statistics.