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. 2022 Apr;37(5):1211-1217.
doi: 10.1007/s11606-022-07422-7. Epub 2022 Feb 7.

The Ecology of Medical Care During the COVID-19 Pandemic in Japan: a Nationwide Survey

Takuya Aoki  1   2 , Masato Matsushima  3
Affiliations

The Ecology of Medical Care During the COVID-19 Pandemic in Japan: a Nationwide Survey

Takuya Aoki et al. J Gen Intern Med. 2022 Apr.

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on health care utilization. However, the overall picture of shifts in health care utilization remains unclear.

Objective: We assessed the ecology of medical care during the COVID-19 pandemic in Japan and compared it with the results pre-pandemic. We also investigated the associations of sociodemographic and clinical factors with health care utilization during the COVID-19 pandemic.

Design and methods: We conducted a nationwide cross-sectional survey of a representative sample of the general Japanese adult population in May 2021. The main outcomes were health care utilization for health-related events in the last month. We assessed sociodemographic and clinical factors, including age, sex, years of education, annual household income, social isolation, and the number of chronic conditions.

Key results: Data were analyzed from 1747 respondents. Over-the-counter drug use, physician's office visits, and hospital outpatient clinic visits decreased drastically during the COVID-19 pandemic compared with pre-pandemic levels. The decrease in the use of medical facilities was especially pronounced among the elderly. Sociodemographic and clinical factors were differently associated with health care utilization during the COVID-19 pandemic. Social isolation and years of education were positively associated with over-the-counter drug use, while female sex was associated with increased over-the-counter drug use and physician's office visits. In addition, the number of chronic conditions was associated with increased hospital visits.

Conclusions: During the COVID-19 pandemic, the use of medical facilities for health-related events decreased drastically, especially among the elderly. A pharmacy is an important source of health care in a population with social isolation. These findings may be useful to researchers and policymakers in rethinking health care systems during and after the pandemic.

Keywords: COVID-19; Japan; delivery of health care; health behavior.

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Conflict of interest statement

Drs. Aoki and Matsushima received lecture fees and lecture travel fees from the Centre for Family Medicine Development of the Japanese Health and Welfare Co-operative Federation. Drs. Aoki and Matsushima are advisers of the Centre for Family Medicine Development practice-based research network. Dr. Matsushima’s son-in-law worked at IQVIA Services Japan K.K. which is a contract research organization and a contract sales organization. Dr. Matsushima’s son-in-law works at SYNEOS HEALTH CLINICAL K.K. which is a contract research organization and a contract sales organization.

Figures

Figure 1
Figure 1
Comparison of health care utilization among non-elderly adults (< 65 years old) between the previous study in 201315and the present study in 2021.
Figure 2
Figure 2
Comparison of health care utilization among elderly (≥ 65 years old) between the previous study in 201315and the present study in 2021.
See this image and copyright information in PMC

Comment in

  • Response to Letter to the Editor: Ecology of Medical Care.
    Aoki T, Matsushima M. Aoki T, et al. J Gen Intern Med. 2022 Nov;37(15):4012. doi: 10.1007/s11606-022-07656-5. Epub 2022 May 13. J Gen Intern Med. 2022. PMID: 35562566 Free PMC article. No abstract available.
  • Ecology of Medical Care.
    Shibata M, Kanaoka K, Banno M. Shibata M, et al. J Gen Intern Med. 2022 Nov;37(15):4011. doi: 10.1007/s11606-022-07659-2. Epub 2022 May 19. J Gen Intern Med. 2022. PMID: 35590023 Free PMC article. No abstract available.

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