Not only did healthcare utilization not reach expected levels in the spring of this year, but care delays also remained prevalent, especially among racial minorities, according to a set of new reports.

In the week beginning April 3, hospital admissions were 85.5% of what was expected based on historic patterns, according to an analysis by Epic Health Research Network and Kaiser Family Foundation. On average, over the first quarter of 2021, hospital admission rates were 89.4% of what would have been expected if the Covid-19 pandemic had not hit.

The analysis assessed data for nearly 10 million admissions in the Epic EHR system through April 9. Expected admission rates are based on historic utilization patterns prior to the pandemic.

Covid-19 is still driving a large share of hospital admissions. In fact, if coronavirus patients are removed from the analysis, all other admissions would be 80.7% of expected levels based on pre-pandemic healthcare utilization in the week of April 3.

Patients intentionally forgoing care could be the driving force behind the low utilization numbers.

In April 2021, 11% of adults reported delaying or going without at least one type of care in the past month due to fear of being exposed to Covid-19, according to a report by the Robert Wood Johnson Foundation. Additionally, 9.2% of parents delayed or did not get care for their children for the same reason.

The report used data from Urban Institute’s April 2021 Health Reform Monitoring Survey, which polled 9,067 U.S. adults, aged 18 to 64.

Delaying or forgoing care was more common among Hispanic and Black adults. About 16.2% of Hispanic and 13.3% of Black adults said they delayed or did not get care in the past 30 days as compared to 8.7% of White adults.

Similarly, adults with family incomes below 250% of the federal poverty level were more likely than adults with higher incomes to avoid care — 14.9% of the former versus 8.2% of the latter.

The most common type of delayed care for adults was dental care (6.8%), followed by general doctor or specialist visits (5.4%), preventive health screenings or medical tests (4.5%) and hospital visits (3.4%).

Dental care was also the most common type of delayed or forgone care among children (5.3%), followed by checkups; well-child visits or other preventive health screenings; general doctor or specialist visits; and routine immunizations.

Physicians are concerned about this ongoing trend.

“By postponing healthcare services and appointments, you can end up masking a potentially serious health concern, such as cancer, diabetes, heart disease, STDs and other chronic conditions,” said Dr. Janice Johnston, family practitioner and co-founder and CMO of health plan provider Redirect Health, in an email. “If you are experiencing symptoms or just need to do a routine check-up, you should not forgo receiving care. Medical professionals take the necessary steps within hospitals and clinics to help ensure the health and safety of patients and staff.”

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