Associations of the COVID-19 pandemic with older individuals’ healthcare utilization and self-reported health status: a longitudinal analysis from Singapore

Sang Nam Ahn, Seonghoon Kim, Kanghyock Koh

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)


Background: The COVID–19 pandemic has challenged the capacity of healthcare systems around the world and can potentially compromise healthcare utilization and health outcomes among non-COVID–19 patients. Objectives: To examine the associations of the COVID-19 pandemic with healthcare utilization, out-of-pocket medical costs, and perceived health among middle-aged and older individuals in Singapore. Method: Utilizing data collected from a monthly panel survey, a difference-in-differences approach was used to characterize monthly changes of healthcare use and spending and estimate the probability of being diagnosed with a chronic condition and self-reported health status before and during the COVID-19 outbreak in 2020. Subjects: Data were analyzed from 7569 nationally representative individuals from 2019 January and 2020 December. Measures: Healthcare utilization and healthcare spending by medical service categories as well as self-reported health status. Results: Between January and April 2020 (the first peak period of COVID-19 in Singapore), doctor visits decreased by 30%, and out-of-pocket medical spending decreased by 23%, mostly driven by reductions in inpatient and outpatient care. As a result, the probability of any diagnosis of chronic conditions decreased by 19% in April 2020. The decreased healthcare utilization and spending recovered after lifting the national lockdown in June, 2020 and remained similar to the pre-pandemic level through the rest of 2020. Conclusions: Middle-aged and older Singaporeans’ healthcare utilization and the diagnosis of chronic conditions substantially decreased during the first peak period of the COVID-19 outbreak. Further studies to track the longer-term health effect of the pandemic among non-COVID-19 patients are warranted.

Original languageEnglish
Article number66
JournalBMC Health Services Research
Issue number1
Publication statusPublished - 2022 Dec

Bibliographical note

Funding Information:
This research is supported by the Ministry of Education, Singapore under its Academic Research Fund Tier 3 (MOE2019-T3–1-006), the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea (NRF-2021S1A5A2A03064205) and the IZA Coronavirus Emergency Research Thrust fund.

Publisher Copyright:
© 2022, The Author(s).


  • COVID–19
  • Healthcare spending
  • Healthcare utilization
  • Pandemic
  • Self-reported health status

ASJC Scopus subject areas

  • Health Policy


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