Pandemic and hospital avoidance: Evidence from the 2015 Middle East respiratory syndrome outbreak in South Korea

Abstract

Existing literature shows that people exhibit disease avoidance behaviors in response to contagious disease outbreaks. We examine hospital avoidance behaviors during the 2015 Middle East respiratory syndrome (MERS) outbreak in South Korea. The outbreak provides an excellent setting for the analysis because unlike the coronavirus disease-19 (COVID-19) situation, no mandatory lockdown was imposed during the outbreak, and the economic impact was also not large. Hence, reduced hospital visits are likely to reflect the public's intention to avoid hospitals to protect themselves from getting infected with MERS. Moreover, the outbreak did not spread to the entire country and vanished after a short period of time, allowing us to consider the affected regions as the treatment group and the other regions as the control group without much concern of confounding by other factors. The data come from a government agency, which assesses (national) health insurance claims made by hospitals, and hence cover all outpatient visits in the country. We find that people reduced outpatient visits by about 17% in response to the MERS outbreak, and the response was the most intense when new cases were reported most frequently.

Keywords: Contagious disease; Disease avoidance behavior; Hospital avoidance; Middle East respiratory syndrome; Pandemic.

Fig. 1

Total number of 2015 MERS cases and deaths in South Korea. Out of 186 MERS cases and 38 deaths, 168 cases and 33 deaths were reported in June. October and November recorded one death each.

Fig. 2

Google search for face mask and hand sanitizer in 2015. These figures show weekly search volume in 2015 for face mask and hand sanitizer, relative to the volume during a week recording the highest during the year, or the week of May 31. A value of 100 is assigned to the week of May 31, and other weeks have a proportional value.

Fig. 3

The daily average of outpatient visits to the five clinics in each month. The five clinics are internal medicine, pediatrics, family medicine, otolaryngology, and general practice. The four affected regions are Seoul, Gyeonggi, Chungnam, and Daejeon, and other regions are the other 12 regions.

Fig. 4

The effect of MERS on log number of outpatient visits to the five clinics. The five clinics are internal medicine, pediatrics, family medicine, otolaryngology, and general practice. May 2015 is zero month from the MERS outbreak. The regression also includes a constant, year/month, and region fixed effects. The standard errors are clustered at the region/year level. The solid line indicates the coefficients, and the dotted lines indicate 95% confidence interval.

Fig. 5

The effect of MERS on log number of outpatient visits to the five clinics excluding the four neighboring regions (Incheon, Gangwon, Chungbuk, and Jeonbuk). Please refer to the note in Fig. 4.

Fig. A.1

Map of Korea.

Fig. A.2

The 2015 monthly unemployment rates for the whole country and four affected regions. These figures show the monthly unemployment rates in 2015. The solid line represents the whole country, and the other four lines represent the four affected regions.