The effect of age-specific stay-at-home recommendation on healthcare utilization: Evidence from Finland's COVID-19 policy.

In early March 2020, World Health Organization (WHO) declared the coronavirus (COVID-19) outbreak a global pandemic due to its widespread distribution and severity []. Prior to the adoption of worldwide social distancing measures, several reports indicated that case-fatality rates among COVID-19 patients in China and Italy increased exponentially with age [, ]. Following the WHO’s emphasis on the heightened risk for older adults and individuals of all ages with pre-existing medical conditions [], many governments implemented stay-at-home recommendations with varying levels of stringency, often specifically targeting older populations []. Prior studies have found reductions in healthcare utilization during the pandemic, especially among individuals without severe health issues [–]. These declines may be attributed to decreased mobility and the reduced spread of infectious diseases due to distancing policies, or to the intentional reduction of non-urgent activities aimed at preventing healthcare sectors from becoming overwhelmed. [–]. Postponements of non-acute care commonly raised concerns about preventable hospitalizations and increased healthcare costs, particularly among older adults at higher risk for ambulatory care sensitive conditions (ACSC) and functional decline [–]. These hospitalizations burden both patients and healthcare payers, including insurers and health authorities [, , ]. Thus, understanding how delays in healthcare access are related to later health outcomes is crucial for informing future healthcare policies that aim to ensure timely access to essential care and mitigate the risks of preventable hospitalization and worsening health conditions. We study the effect of the Finnish age-specific stay-at-home recommendation on healthcare utilization, using extensive Finnish register data. In Finland, the government declared a state of emergency on March 16, during which individuals aged 70 and above were instructed to remain in quarantine-like conditions. The measure, commonly called as lockdown, was in effect until June 23, 2020. Using nationwide register data from Finland, we apply regression discontinuity (RD) design to compare individuals who were just over 70 years old when the policy was issued with those being just under 70 years old at the same time. Specifically, we examine the impacts on primary care, dental care, physiotherapy, non-acute specialized care and emergency department visits, as well as hospitalization. Building on earlier literature, we also explore effects on psychotropic drug and antibiotics use, and mortality during the lockdown. Additionally, we investigate potential heterogeneous effects for different subgroups, accounting for health risk factors for severe COVID-19 disease and region of residence.