Impact of Coronavirus Disease 2019 on Inpatient Palliative Care Services in Japan: A Hybrid Time-Series Analysis Before, During, and After the Pandemic Using 10-Year Claims Data.

BACKGROUND

Coronavirus disease 2019 (COVID-19) reduced the use of routine medical care, particularly the treatment of nonlife-threatening conditions. Previous studies have examined the impact of the COVID-19 pandemic; however, most focused on the effect of early stages, lacking data on the later stages and post-pandemic recovery.

OBJECTIVE

To examine the impact of COVID-19 on inpatient palliative care services in Japan throughout the pandemic and after its reclassification as a Category 5 infectious disease.

DESIGN

Retrospective time-series analysis of claims data from April 2014 to March 2024.

SETTING/SUBJECTS: National Health Insurance participants in Kanagawa Prefecture who received the "Palliative Care Unit Inpatient Fee" or "additional fee for inpatient palliative care treatment."

MEASUREMENTS: The observed-to-expected (OE) ratios were calculated using Seasonal Autoregressive Integrated Moving Average model predictions. Interrupted time-series (ITS) analysis was used to examine the level and trend changes after the reclassification of COVID-19 to Category 5 (May 2023).

RESULTS

During COVID-19, the Palliative Care Unit Inpatient Fee showed OE ratios ranging from -25.1% to 22.9% (April 2020-November 2021), which eventually reached -36.0% (October 2022). After COVID-19 reclassification, OE ratios improved to -9.5% to 12.5%. Additional fees for inpatient palliative care treatment showed similar patterns, with the lowest point being -42.7% (February 2022). The ITS analysis revealed significant positive trends for both services after reclassification.

CONCLUSIONS

The COVID-19 pandemic has influenced inpatient palliative care services, particularly since its sixth wave. The reclassification of COVID-19 to Category 5 showed immediate positive effects, suggesting that policy interventions can effectively restore palliative care services. These findings highlight the vulnerability of palliative care, impact of policy interventions during pandemics, and need for strategic planning in a future-aging society.