Trend in the admissions of patients with non-COVID-19 respiratory symptoms during COVID-19 pandemic and its impact on hospital finances in Surabaya, Indonesia

Background: COVID-19 cases surge, it has a crucial impact on healthcare systems, with rapidly increasing demand for healthcare resources in hospitals and intensive care units (ICUs) in Indonesia and worldwide. It is necessary to quantify the extent to which the effects of the COVID-19 pandemic on the hospital admissions, and clinical and financial outcomes of patients with non-COVID-19 respiratory symptoms.Objective: To determine whether the COVID-19 pandemic changed the hospitalisation of child and adult patients with non-COVID-19 respiratory conditions and whether these changes affected the patient's disease condition, clinical outcomes, and hospital finances.Methods: A retrospective cohort study was conducted from May 1, 2018 (before the COVID-19 pandemic) until December 31, 2021. Total sampling was done to compare hospital admission of patients with non-COVID-19 respiratory symptoms before versus during the COVID-19 pandemic. The results were analyzed using SPSS 26.0 and SmartPLS.v.3.2.9.Results: There was a reduction in hospitalisations for respiratory disorders unrelated to COVID-19 during the pandemic by 55.3% in children and 47.8% in adult patients. During the pandemic, the average hospital revenue per patient of child and adult patients increased significantly, but the profit per patient decreased. Pathway analysis showed that in children, the COVID-19 Pandemic changed disease severity and complexity (beta = 0.132, P < 0.001), as well as clinical outcomes (beta = 0.029, P < 0.05). In adults, the COVID-19 pandemic improves disease severity and complexity (beta =-0.020, P < 0.001), as well as clinical outcomes (beta =-0.013, P < 0.001). COVID-19 pandemic increases care charges (in children with beta = 0.135, P < 0.001; and in the adult patients with beta = 0.110, P < 0.001), worsens hospital financial outcomes relating to child (beta =-0.093, P < 0.001) and adult patient (beta =-0.073, P < 0.001). In adult patients, seasonal variations moderate the impact of the COVID-19 pandemic on improving disease conditions (beta =-0.032, P=<0.001). The child structural model effectively predicted clinical outcomes (Q2 = 0.215) and financial out-comes (Q2 = 0.462). The adult structural model effectively predicted clinical outcomes (Q2 = 0.06) and financial outcomes (Q2 = 0.472).Conclusion: The conclusions are that the number of non-COVID respiratory patients decreased during the COVID-19 pandemic (47.8% in adult patients, 55.3% in child patients). Disease severity and complexity increased in child patients but decreased in adult patient. Costs of care and insurance payments increased. Since the insurance payments did not increase as much as the cost of care, hospital profit decreased.

Automated summary

The COVID-19 pandemic has led to a decrease in hospitalizations for non-COVID respiratory conditions, with an increase in disease severity among child patients and a decrease in adults. Costs and insurance payments have increased, but hospital profits have decreased due to insurance payments not keeping up with the cost of care.