China’s unique journey through the COVID-19 crisis, as the initial epicenter and one of the last nations to relax stringent containment strategies, has provided a real-world laboratory for assessing the complex interplay between strict public health interventions and routine healthcare delivery. Leveraging extensive aggregated data spanning hospital outpatient visits and admissions across the entire Chinese hospital system between 2020 and 2024, the team uncovered a staggering drop—approximately 7% fewer outpatient visits (totaling 1.2 billion missed encounters) and 13% fewer hospital admissions (141 million fewer hospitalizations)—compared to pre-pandemic expectations.

Notably, despite the formal cessation of the Zero-Covid policy in late 2022, healthcare utilization showed a sluggish and incomplete recovery as of April 2024. The study found that outpatient visits remain below anticipated levels in nearly two-thirds (65%) of China’s provinces and regions, while inpatient admissions continue to lag in about three-quarters (74%) of these areas. This prolonged suppression of healthcare engagement underscores a worrying and likely multifactorial disruption of access to critical health services, even two years post-policy relaxation.

The ramifications extend beyond sheer numbers; these findings reflect profound systemic challenges in re-establishing healthcare service equilibrium amidst residual public caution, infrastructural strains, and perhaps shifts in patient health-seeking behavior. “Understanding how COVID-19 policies reshaped health systems in aggregate helps chart informed pathways toward fortification and rebound,” explains Hong Xiao, PhD, the study’s lead author and a senior scientist at Fred Hutch’s Public Health Sciences Division. According to Xiao, retracing these healthcare utilization trends forms an essential foundation for both recovery and future pandemic preparedness.

A striking element of the analysis pertains to geographic and socioeconomic disparities in healthcare disruption and recovery. While metropolitan hubs such as Shanghai and Beijing experienced the highest absolute volume declines, relative reductions in service use were most acute in rural and less-developed regions. These findings echo global patterns where lower-resourced areas disproportionately bear the brunt of healthcare access shortfalls, exacerbated by logistical hurdles like distance to specialized care facilities. Joseph Unger, PhD, a senior health services researcher at Fred Hutch and co-investigator on the study, draws parallels with rural healthcare inequities seen during the pandemic in the United States, emphasizing a shared global thematic of vulnerable populations facing “disproportionate lack of access, especially to higher-quality, specialized care.”

It is important to note that while the study harnessed comprehensive aggregated hospital data across China, the absence of granular demographic variables limits differentiation according to socioeconomic status, ethnicity, or other social determinants of health. This gap signals a critical direction for future research aimed at disentangling the nuanced drivers and consequences of healthcare inequities exacerbated or unveiled during the pandemic era.

The broader context of healthcare recovery following pandemics sheds further light on the uneven rebound observed in China. For example, Liberia’s healthcare utilization recovered within a year after the 2014-15 Ebola outbreak, while Guinea’s recovery was more protracted. Similarly, in the COVID-19 context, Japan experienced slower inpatient volume recovery compared to California, whereas South Korea’s healthcare use rapidly reverted to pre-pandemic norms. Such disparities underscore that healthcare system resilience is intricately linked to local policy choices, infrastructure robustness, public trust, and adaptive capacity.

In response to these insights, the authors advocate for robust future pandemic preparedness strategies incorporating healthcare surge capacity, innovative models of care such as telemedicine, and finely tuned public communication campaigns to sustain essential healthcare access during public health emergencies. Targeted interventions in regions with pre-existing healthcare disparities are especially critical, as these areas are less resilient to the shocks induced by stringent control measures.

Xiao stresses the imperative of balancing aggressive infectious disease containment with the uninterrupted provision of essential healthcare services to mitigate collateral damage. This balancing act is no trivial pursuit; overzealous constraints risk widening healthcare gaps and triggering downstream adverse population health effects. As countries rebuild and strengthen healthcare infrastructure in the aftermath of COVID-19, these lessons from China furnish a cautionary yet invaluable blueprint for safeguarding equitable healthcare continuity against future global health crises.

The meticulous interrupted time-series analysis deployed in this investigation draws upon one of the largest aggregated hospital datasets ever compiled, covering outpatient visits and inpatient admissions over a five-year trajectory from 2020 through early 2024. This robust methodological approach enables precise quantification of deviations from expected utilization trends, contextualized against the timeline of evolving public health policies, most notably the Dynamic Zero-Covid approach and its subsequent abandonment.

This research occupies a pivotal space within a growing literature exploring the unintended consequences of rigorous pandemic containment policies—not just on excess mortality and infection control but on longitudinal healthcare system functioning and population health outcomes. As the first country to implement widespread COVID-19 measures and among the last to relax them, China’s healthcare utilization trajectory offers a cautionary tale, highlighting how swift policy decisions to curb viral spread might inflict sustained disruptions on routine healthcare delivery infrastructures.

In an era where pandemic preparedness plans are under intense global scrutiny, this study serves as a clarion call for nuanced policy designs that anticipate and mitigate adverse collateral impacts on health services. The interplay of infectious disease control and healthcare system sustainability demands sophisticated, equity-centered approaches, especially in nations with diverse regional capacities and pre-existing disparities in healthcare accessibility.

In summary, the enduring downturn in healthcare service utilization across China from 2020 to 2024 revealed by this study adds critical depth to our understanding of the multifaceted impact of COVID-19 policies. As China, and indeed the world, continue to move forward in pandemic recovery and resilience building, policymakers must reckon with and address these silent, pervasive reverberations to safeguard public health comprehensively.

Subject of Research: People

Article Title: Policy stringency during the COVID-19 pandemic and healthcare services utilization in China: An interrupted time-series analysis

News Publication Date: May 20, 2026

Web References:
https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004672

References:
Xiao H, Unger J, et al., PLOS Medicine, 2026

Keywords: Public policy, Quarantines, SARS CoV 2

The analysis involved a comprehensive examination of insurance claims data covering approximately 8.1 million patients across all 50 states from January 30, 2020, to June 30, 2023. The researchers discovered that nearly three million prescriptions related to COVID-19 were issued for hydroxychloroquine and ivermectin, culminating in an astounding $272 million spent on these medications. The figures suggest not only a significant spike in prescribing behavior but also highlight the continued financial burden on the healthcare system as patients sought treatments with little to no evidence demonstrating their efficacy against the virus.

Diving deeper into the demographics, it was reported that the prescribing of ivermectin showed notable disparities by socioeconomic status. The drug’s use was particularly high among individuals residing in socially vulnerable neighborhoods, indicating a potential linkage between misinformation and healthcare access within these communities. Furthermore, older adults aged 65 and above received these prescriptions at rates threefold higher than their younger counterparts, exacerbating concerns about the risks they face from these purported treatments. In addition, regional variations were pronounced, with the Southern United States displaying a markedly higher rate of ivermectin prescriptions compared to other areas.

Despite initial surges in the utilization of hydroxychloroquine and ivermectin, prescriptions plummeted by a staggering 93% once FDA-authorized COVID-19 treatments became available, such as Paxlovid. This decline occurred between March 2022 and June 2023, showcasing a pivotal shift in treatment protocols as evidence-based medications entered the market. However, a concerning $18 million continued to be spent on hydroxychloroquine and ivermectin in the wake of these favorable treatment options, further underscoring a reliance on non-evidence-based care paths.

One would ponder the origins of such misconceptions surrounding hydroxychloroquine and ivermectin that fueled this extensive use within society. The factors are complex and rooted in a multifaceted interplay between public sentiment, misinformation, and mistrust in established scientific institutions. Dr. John Mafi, a senior author of the study, pointed out that the data represents a critical failure in public health messaging, exacerbating reliance on ineffective treatments amidst a worldwide crisis demanding clear and effective guidance.

The unprecedented healthcare challenges of the COVID-19 pandemic demanded urgent responses from policy makers and healthcare providers alike. Yet, these responses were often hampered by a torrent of misinformation that clouded public understanding of the disease and its treatments. The study brings to light the pressing need for policy reforms geared toward correcting these misconceptions. As suggested by Dr. Mafi, eliminating undue influences from the pharmaceutical industry in policy-making, enhancing transparency surrounding scientific uncertainties, and ensuring public funding for robust clinical trials are fundamental steps necessary for improving public trust.

In addition to potential policy shifts, the implications of this research call for a renewed focus on health literacy. The high levels of stroke patients turning to hydroxychloroquine and ivermectin can be attributed to widespread misconceptions surrounding COVID-19 treatments. Increasing awareness about the importance of using evidence-based medicine is essential in averting reliance on medications that may do more harm than good. The findings suggest that health promotion strategies must begin to cater to vulnerable populations effectively, given their apparent susceptibility to misinformation.

As researchers continue to analyze data relating to the pandemic, one fundamental question remains: what role does the healthcare community play in shaping public perceptions around treatment options? The pandemic revealed significant gaps in communication strategies from health institutions. The challenges faced during COVID-19 warrant a paradigm shift in how medical establishments engage with patients regarding treatment options. Fostering an environment that emphasizes scientific literacy and critical assessment of information sources is imperative to empowering patients to make informed healthcare decisions in future health crises.

The study’s findings also reveal the broader societal implications stemming from the financial burdens associated with ineffective treatments. The $272 million spent on hydroxychloroquine and ivermectin could have instead been allocated to promoting genuine evidence-based treatments, preventative measures, and other essential healthcare functions. As the healthcare landscape continues to evolve in the coming years, it will be vital to address these economic impacts and reallocate resources toward maintaining a high standard of care.

Moreover, this study serves as a wake-up call for health authorities and researchers alike. Understanding the trajectories of medication utilization during the pandemic builds a foundation for addressing similar situations in the future. Implementing data-driven approaches for tracking prescribing patterns can unveil critical insights for preemptive measures against the surge of ineffective treatments. Achieving a significant reduction in reliance on non-evidence-based care requires unified efforts from various societal stakeholders, including policymakers, healthcare providers, and the community at large.

After extensive research and evidence, while hydroxychloroquine and ivermectin have been deemed ineffective against COVID-19, their prescription rates soared due in part to misinformation and societal factors. As we move forward, the salient lessons illustrated by this study must inform public health policies geared toward areas of misinformation and treatment efficacy. Sifting through the barrage of countless treatment options during a healthcare crisis can be overwhelming; however, clear scientific evidence should always prevail in the pursuit of better health outcomes.

Ultimately, the trends observed in this UCLA-led research call for a shared responsibility to advocate for evidence-based treatment and prioritize healthcare literacy across the board. The fight against misinformation starts with fostering transparency in communication channels and empowering patients to demand scientifically-backed treatment options.

As society attempts to recover from the pandemic’s impacts, balancing a return to normalcy with the lessons learned about public health, misinformation, and treatment efficacy will be key to ensuring a more resilient healthcare system in the future. The time to act is now, and the responsibility lies within the collective effort of individuals, healthcare professionals, and policymakers committed to fostering a healthier, more informed society.

Subject of Research:
Article Title: Demographic Variation In US Outpatient Hydroxychloroquine And Ivermectin Use During The COVID-19 Pandemic
News Publication Date: 19-Feb-2025
Web References: Health Affairs DOI
References: None
Image Credits: None

Keywords: COVID 19, Clinical research, Public health, Drug studies, Health care, Drug therapy, Insurance, United States population