Impact of SARS on healthcare utilization by disease categories: Implications for delivery of healthcare services

OBJECTIVE: To assess the impact of the SARS epidemics in Taiwan on ambulatory care and inpatient utilization by disease categories and accreditation levels of hospital. METHODS: The National Health Insurance claims data of Taipei were analyzed. We calculated the changes in utilization between June 2002 and June 2003 to estimate the impact that SARS had on utilization. RESULTS: The top three disease categories with the most significant drop in utilization were gastroenteritis (−53%), acute bronchitis (−45%), and tonsillitis (−40%) in ambulatory care and acute bronchitis (−82%), gastroenteritis (−72%), and pneumonia (−64%) in inpatient care. On the other hand, the disease categories with the smallest reduction were allergic reactions (−4%), skin infections (−6%), and anxiety (−10%) in ambulatory care and respiratory failure (+40%), delivery (−2%), and fractures of lower limbs (−5%) in inpatient care. CONCLUSIONS: Disease categories could be classified into three groups according to the extent of change in utilization during the SARS outbreaks. Diseases with a prominent reduction were respiratory diseases, minor problems, and elective procedures. Diseases with a moderate reduction were mainly chronic diseases. Diseases with a limited reduction were acute conditions, difficult mental disorders, or procedures that could not be postponed. The utilization of some diseases shifted significantly from medical centers to district hospitals or clinics.