Researchers identify trends in healthcare access and use that should inform future pandemic policies
SEATTLE – May 20, 2026 – A PLOS Medicine analysis led by Fred Hutch Cancer Center researchers quantified the enduring impact that China's health policies during the COVID-19 pandemic had on overall healthcare utilization. As the first country to report COVID-19 cases and implement infection control measures, and among the last to lift such policies, China's experience presented a unique opportunity to study the relationship between public health measures and healthcare access.
Based on publicly available aggregate data from all hospitals in China, the researchers discovered substantial, long-term declines in outpatient clinic visits (7%, or 1.2 billion) and hospitalizations (13%, or 141 million) compared to expected levels from 2020 to 2024 in China. Although China's stringent public health policy, Dynamic Zero-Covid, was lifted in late 2022, the study found that as of April 2024, outpatient clinic visits did not rebound to expected levels in 65% of China's regions and hospitalizations remained below expected levels in 74% of the country's regions.
"This study is part of a broader line of research that examines how COVID-19 pandemic measures affected many aspects of health, from access to cancer clinical trials in the U.S. to access to cancer healthcare and excess all-cause mortality in China," said Hong Xiao, PhD, staff scientist in the Public Health Sciences Division at Fred Hutch and first author of the study. "Understanding the extent to which COVID-19 policies have shaped health, collectively, provides importance guidance on how to improve health systems."
Regional disparities in access
Xiao and collaborators observed regional disparities in healthcare utilization, with the most significant and long-term impact observed in China's rural and less-developed regions. Although urban areas such as Shanghai and Beijing experienced the largest absolute reductions in healthcare utilization during the COVID-19 pandemic, the largest relative reductions in access were found in less developed regions.
"Similar to the U.S., rural communities in China experienced a disproportionate lack of access to healthcare associated with the COVID-19 pandemic, especially reduced access to higher-quality and specialized care due to the need to travel long distances," noted Joseph Unger, PhD , a health services researcher and biostatistician at Fred Hutch and study senior author. "This analysis helps to further clarify the durable impact the COVID-19 pandemic had across countries."
The researchers pointed out that the healthcare data used in this study was available at the aggregate level and did not include demographic data. Therefore, this study doesn't provide information about potential disparities across socioeconomic groups or based on social determinants of health.
Policy lessons for the next pandemic
Healthcare utilization following pandemics and outbreaks has varied globally. After the 2014-2015 Ebola outbreak, healthcare utilization in Liberia rebounded to expected levels within a year, while in Guinea, recovery was slower. Similarly, after the acute phase of the COVID-19 pandemic, inpatient volumes in Japan recovered more slowly than was observed in California, and in South Korea, healthcare use rebounded quickly to pre-pandemic levels.
Based on the study findings, the researchers recommended that future preparedness efforts should include surge capacity planning, alternative care delivery models like telemedicine and targeted public communication. Additionally, specific policies should be developed to improve healthcare access and utilization in regions and local health systems that already experience disparities.
"As we rebuild health systems to be more resilient in the face of future challenges, we clearly need to focus on regions where we already see that healthcare infrastructure is underdeveloped and healthcare access is inequitable," said Xaio. "While this study focused on China's experience, the lessons are invaluable to health policymakers globally: we must thoughtfully balance public health interventions with essential healthcare services."
About the study
The authors have declared that no competing interests exist.
Research reported in this publication was supported by the Public Health Sciences Division of the Fred Hutch Cancer Center (to JMU) and "2022 Zhejiang Province High-Level Talent Training Program - Medical Rising Star Fund Support" (to YC). The funders had no other role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
