Impacts of the COVID-19 Pandemic on Public Hospitals of Different Levels: Six-Month Evidence from Shanghai, China

Abstract

Yuqian Chen,1 Miao Cai,2 Zhipeng Li,3 Xiaojun Lin,4,5 Linan Wang6 1Department of Health Policy Research, Shanghai Health Development Research Center, Shanghai, People’s Republic of China; 2Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China; 3Qu Qiubai School of Government, Changzhou University, Changzhou, Jiangsu, People’s Republic of China; 4HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 5Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 6School of Public Economics and Administration, Shanghai University of Finance and Economics, Shanghai, People’s Republic of ChinaCorrespondence: Linan WangSchool of Public Economics and Administration, Shanghai University of Finance and Economics, No. 777 Guoding Road, Yangpu District, Shanghai, 200433, People’s Republic of ChinaTel [phone]Fax [phone]Email [email protected] LinWest China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan, 610041, People’s Republic of ChinaTel [phone]Email [email protected]: Hospitals suffered from a precipitous loss of medical service globally due to COVID-19. The tragedy paradoxically produced an opportunity to investigate the patterns of change in medical services and revenue in hospitals at different levels when faced with a natural shock. This study aims to examine the effects of the COVID-19 pandemic in the first half of 2020 on hospital operation in Shanghai.Methods: We obtained monthly characteristic and operational data of public hospitals (N=156) from January 1, 2018, to July 31, 2020, in Shanghai from the China Statistical Survey of Health Resources and Services Program. We constructed a set of difference-in-differences models to investigate the pandemic (from February 1 to March 31, 2020) and post-pandemic (from April 1 to July 31, 2020) effects on operational outcomes in hospitals of different levels, including outpatient and inpatient visits, outpatient and inpatient revenue, as well as the differential effects on local and nonlocal patients.Results: There were 46 tertiary hospitals and 110 non-tertiary hospitals involved in this study. Compared to a non-tertiary hospital during the COVID-19 pandemic, a tertiary hospital averagely experienced substantially more significant losses in outpatient visits (57.91 thousand, p < 0.01), inpatient visits (1.93 thousand, p < 0.01), outpatient revenue (18.88 million RMB, p < 0.01), and inpatient revenue (30.65 million RMB, p < 0.01) monthly. Compared to a non-tertiary hospital in the post-pandemic period, a tertiary hospital averagely lost more outpatient visits (18.02 thousand, p < 0.01) from all patients and inpatient visits (0.15 thousand, p < 0.01) from nonlocal patients, but was associated with higher inpatient revenue (2.24 million RMB, p < 0.01) from all patients and outpatient revenue (0.87 million RMB, p < 0.01) from nonlocal patients monthly.Conclusion: Medical service and revenue for public hospitals in Shanghai dropped precipitously during the COVID-19 pandemic, but mainly recovered after the pandemic. Compared to non-tertiary hospitals, medical services and revenue in tertiary hospitals experienced more substantial reduction during the pandemic but had a faster recovery that maintained longer during the post-pandemic period.Keywords: COVID-19, health services research, health utilization, hospital level

Keywords

• covid-19
• health services research
• health utilization
• hospital level