ABSTRACT
The COVID-19 pandemic and measures taken to decrease the spread impacted youth in foster care and foster parents in a myriad of ways. One critical yet unexplored area is how educational changes during the first 2 years of the pandemic impacted this specific group of youth in foster care and foster parents. This exploratory study used three methods: (1) A scoping review of the prior research on pandemics/climate events and school closures and the research from early 2020; (2) individual interviews and focus groups with foster parents and teachers; and (3) an online survey of 88 foster parents. We endeavored to include findings at each stage of the process. Research from prior epidemics and school closures and predictive models predicted learning losses which were verified by the findings in the survey and interviews. Foster parents reported that the youth in foster care had great difficulty concentrating with on-line delivery and the absence or greatly limited access to mental health services compounded the challenges. Even as children returned to classrooms, the behavior of children, youth resulted in suspensions and expulsions likely increasing learning losses. The discussion identifies some approaches to addressing COVID-19 learning gaps and the mental health needs of this vulnerable group of children and youth.
ABSTRACT
Objectives: The COVID-19 pandemic affected healthcare use globally. However, there have been few studies examining how it affected age-specific healthcare use by patients as related to the locations of healthcare institutions. We explore changes in healthcare use while focusing on age-specific patient groups and facility locations after the COVID-19 pandemic. Methods: We compared two databases of cross-sectional outpatient health-insurance claims that have equivalent time points yearly and quarterly both before and after the COVID-19 pandemic. We categorized patients of healthcare institutions into five age groups and two facility locations. Results: The number of claims in 2020 significantly decreased by about 15% compared to 2019. The greatest reduction was for patients aged under 20 (-43.7%), followed by the 20-39 group (-15.0%) and the 40-59 group (-11.9%). Moreover, the number of claims significantly decreased in both urban and rural areas (p< 0.001); however, the magnitude of this decrease was greater in urban areas (-15.2%) than in rural areas (-10.8%). The annual decrease in healthcare use by age groups and location of facility was still supported even after controlling for institutional covariates, except for the patient group aged 80 or over in rural areas. Conclusions: We found that the COVID-19 pandemic critically affected healthcare use across age-specific population groups and different locations of healthcare institutions. It suggests there is a need for further research and policy implications as to whether the declining healthcare use among those age groups is in core health care, and as to whether there are any unmet healthcare needs.
ABSTRACT
Objectives Many small-sized healthcare institutions play a critical role in communities by preventing infectious diseases. This study examines how they have been impacted by the global COVID-19 pandemic compared with large hospitals. Design This study adopted a retrospective study design looking back at the healthcare utilisation of medical facilities according to size after the COVID-19 pandemic. The dependent variable was change in the number of outpatient health insurance claims before and after onset of the COVID-19 pandemic. The independent variable was an observation time point of the year 2020 compared with 2019. Setting and participants The study was conducted in Korea having a competitive medical provision environment under the national health insurance system. The units of analysis are hospitals and clinics: tertiary hospitals (42), general hospitals (293), small hospitals (1272) and medical clinics (27 049). This study analysed all the health insurance claim data from 1 January 2019 to 31 December 2020. Results Compared with 2019, in 2020, there were significant decreases in the number of claims (−14.9%), particularly in small hospitals (−16.8%) and clinics (−16.3%), with smaller decreases in general hospitals (−8.9%) and tertiary hospitals (−5.3%). The reduction in healthcare utilisation increased as the size of institutions decreased. The magnitude of decrease was significantly greatest in small hospitals (absolute risk (AR): 0.8317, 0.7758 to 0.8915, p<0.0001;relative risk (RR): 0.8299, 0.7750 to 0.888, p<0.0001) followed by clinics (AR: 0.8369, 0.8262 to 0.8478, p<0.0001;RR: 0.8362, 0.8255 to 0.8470, p<0.0001) even after controlling institutional covariates. Conclusion The external impact of the pandemic increased incrementally as the size of healthcare institutions decreased. Healthcare policy-makers need to keep in mind the possibility that small hospitals and clinics may experience reduced healthcare utilisation in the infectious disease pandemic. This fact has political implications for how healthcare policy-makers should prepare for the next infectious disease pandemic.