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Reduction in healthcare services during the COVID-19 pandemic in China
  1. Yi-Na Zhang1,
  2. Yun Chen2,
  3. Ying Wang2,
  4. Fan Li3,
  5. Michelle Pender4,
  6. Na Wang2,
  7. Fei Yan2,
  8. Xiao-Hua Ying2,
  9. Sheng-Lan Tang4,
  10. Chao-Wei Fu2
  1. 1Department of Socail Management and Socail Policy, School of Social Development and Public Policy, Fudan University, Shanghai, China
  2. 2Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China
  3. 3Department of Statistical Science, Duke University, Durham, North Carolina, USA
  4. 4Duke Global Health Institute, Duke University, Durham, North Carolina, USA
  1. Correspondence to Dr Chao-Wei Fu; fcw{at}; Dr Xiao-Hua Ying; xhying{at}


Introduction The COVID-19 pandemic caused a healthcare crisis in China and continues to wreak havoc across the world. This paper evaluated COVID-19’s impact on national and regional healthcare service utilisation and expenditure in China.

Methods Using a big data approach, we collected data from 300 million bank card transactions to measure individual healthcare expenditure and utilisation in mainland China. Since the outbreak coincided with the 2020 Chinese Spring Festival holiday, a difference-in-difference (DID) method was employed to compare changes in healthcare utilisation before, during and after the Spring Festival in 2020 and 2019. We also tracked healthcare utilisation before, during and after the outbreak.

Results Healthcare utilisation declined overall, especially during the post-festival period in 2020. Total healthcare expenditure and utilisation declined by 37.8% and 40.8%, respectively, while per capita expenditure increased by 3.3%. In a subgroup analysis, we found that the outbreak had a greater impact on healthcare utilisation in cities at higher risk of COVID-19, with stricter lockdown measures and those located in the western region. The DID results suggest that, compared with low-risk cities, the pandemic induced a 14.8%, 26.4% and 27.5% reduction in total healthcare expenditure in medium-risk and high-risk cities, and in cities located in Hubei province during the post-festival period in 2020 relative to 2019, an 8.6%, 15.9% and 24.4% reduction in utilisation services; and a 7.3% and 18.4% reduction in per capita expenditure in medium-risk and high-risk cities, respectively. By the last week of April 2020, as the outbreak came under control, healthcare utilisation gradually recovered, but only to 79.9%–89.3% of its pre-outbreak levels.

Conclusion The COVID-19 pandemic had a significantly negative effect on healthcare utilisation in China, evident by a dramatic decline in healthcare expenditure. While the utilisation level has gradually increased post-outbreak, it has yet to return to normal levels.

  • health economics
  • health services research
  • public health
  • infections
  • diseases
  • disorders
  • injuries
  • other study design

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  • Y-NZ and YC are joint first authors.

  • Handling editor Sanni Yaya

  • Contributors C-WF, X-HY and S-LT developed the research question. C-WF, X-HY and Y-NZ oversaw study implementation. Y-NZ and YC were responsible for the data analysis and drafting the manuscript. C-WF, S-LT, YW, FL, MP, NW, FY, and X-HY assisted with the study design, data analysis, data interpretation and reviewed the manuscript. The authorship order among cofirst authors was assigned according to contributions. All authors read and approved the final manuscript.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request from C-W Fu emailed to The data are daily transactions for healthcare services and include information on each transaction including date, amount, location and name of the healthcare facility in 365 mainland Chinese cities during 8 January to 12 March 2019 and 1 November 2019 to 30 April 2020. The data are available on reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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