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Hospital Avoidance and Unintended Deaths during the COVID-19 Pandemic

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  • Jonathan Zhang

Abstract

The COVID-19 pandemic significantly altered individual behaviors, including the consumption of health care. I study utilization and mortality in the largest integrated health-care system in the United States, the Veterans Health Administration, and find that between the middle of March and the beginning of May 2020, emergency department and inpatient hospital visits declined by 37 percent and 46 percent, and remained 10 percent and 17 percent below expected levels by the end of October. Declines were more pronounced for nonurgent and non-life-threatening conditions, although urgent and life-threatening conditions also dropped by a quarter during the early months. Conditional on arrival at the emergency department, conditions were more severe at presentation. In the first two months of the pandemic, veteran mortality increased by 19.5 percent, yet non-COVID-19 mortality in VA inpatient settings declined. I find suggestive evidence that hospital avoidance may have resulted in higher non-COVID-19 mortality. By focusing on counties with no official COVID-19 deaths by May 19, 2020, I estimate that an upper bound of 7.9 percent of excess veteran deaths in the first two months of the pandemic were due to hospital avoidance.

Suggested Citation

  • Jonathan Zhang, 2021. "Hospital Avoidance and Unintended Deaths during the COVID-19 Pandemic," American Journal of Health Economics, University of Chicago Press, vol. 7(4), pages 405-426.
    • Handle: RePEc:ucp:amjhec:doi:10.1086/715158
    DOI: 10.1086/715158
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    Cited by:

    1. Amy Finkelstein & Geoffrey Kocks & Maria Polyakova & Victoria Udalova, 2022. "Heterogeneity in Damages from A Pandemic," NBER Working Papers 30658, National Bureau of Economic Research, Inc.
    2. Kattih, Nour & Mansour, Fady, 2024. "The impact of the COVID pandemic on health, healthcare utilization, and healthcare spending," Research in Economics, Elsevier, vol. 78(2).
    3. Timothy F. Harris & Aaron Yelowitz & Jeffery Talbert & Alison Davis, 2023. "Adverse selection in the group life insurance market," Economic Inquiry, Western Economic Association International, vol. 61(4), pages 911-941, October.
    4. Wolfgang Frimmel & Gerald J. Pruckner, 2024. "The COVID-19 pandemic and health care utilization: Evidence from Austrian register data," Economics working papers 2024-03, Department of Economics, Johannes Kepler University Linz, Austria.
    5. Abu S. Shonchoy & Shatakshee Dhongde & Erdal Asker, 2023. "COVID-19 Lockdown and Neonatal Mortality: Evidence from India," Working Papers 2303, Florida International University, Department of Economics.
    6. Shooshan Danagoulian & Thomas A. Wilk, 2022. "Locking out prevention: Dental care in the midst of a pandemic," Health Economics, John Wiley & Sons, Ltd., vol. 31(9), pages 1973-1992, September.

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