Impacts of the Pandemic on Utilization of Critical Healthcare among New York Medicaid Beneficiaries with Schizophrenia

ABSTRACT

Background: People with schizophrenia are more likely to become ill with COVID-19 and have poorer COVID-19 outcomes because of pre-existing health conditions and social disadvantage. This risk may be modified by the strength of their connection to the healthcare system. In New York (NY), a state badly impacted by the pandemic, drivers of racial/ethnic healthcare disparities could reduce access to healthcare for minorities relative to white individuals, even if insured. Evidence is limited on the pandemic's impacts on this population's access to behavioral and physical healthcare and whether differences by race/ethnicity exist. Aims of the Study To examine the early impacts of the pandemic on racial/ethnic differences in access to healthcare among adult NY Medicaid beneficiaries with schizophrenia. Methods: We constructed a cohort of Medicaid beneficiaries aged 18-64 with schizophrenia observed in the pre-pandemic period (March 7, 2019-March 6 2020) or in the early post-pandemic period (March 7 - May 15 2020). Outcomes included access to critical behavioral health outpatient care (utilization of routine and specialty services, and antipsychotic drugs) and unavoidable hospitalizations (suicidality, cardiometabolic emergencies, and pneumonia). We estimated logistic regression models for each outcome. The main independent variables were race/ethnicity, time, and their interaction;adjustors included age, sex, disability, and county. Odds ratios (OR) and 95% CI for differences between minorities and whites were computed. Results: We identifed 23,486,821 and 4,481,176 person-days, preand post-pandemic period respectively, with a majority non-white. Utilization and racial/ethnic differences did not change over time for specialty oupatient care, which favored blacks over whites (OR = 1.21, 95% CI = 1.19, 1.24), or hospitalizations for suicidality and cardiometabolic emergencies. Differences in routine outpatient care and antipsychotic utilization between minorities and whites, largely favoring whites, decreased in the post-pandemic period without closing the gaps. Differences in pneumonia hospitalizations changed over time, with minorities less likely than whites to be hospitalized in the post-pandemic period;e.g., Latinx pre-period OR = 0.89, 95% CI = 0.66, 1.18;post-period OR = 0.70, 95% CI = 0.53, 0.87. Discussion and Limitations: We found that access to critical behavioral health care and unavoidable hospitalizations for adults with schizophrenia in NY and differences by race/ethnicity remained largely unchanged following the onset of the pandemic. This constancy is noteworthy given how severely NY and its healthcare system were affected by the pandemic. However, the post-pandemic emergence or widening of racial/ethnic differences in hospitalizations for pneumonia is concerning given the larger burden of COVID- 19 disease observed among minorities. Implications for Health Care Provision and Use Identifying the provider-level factors that enabled the preservation of access to critical behavioral health and hospitalization care will improve the system's capacity to confront future public health emergencies. Implications for Health Policies Our findings suggest that policies that aimed to preserve healthcare access were successful;however, policies are needed to address the potential for racial/ethnic differences in access to care for the public health emergency. Implications for Further Research Future research should assess the impact of variable telehealth adoption on quality and effectiveness of care for this population.