A tale of two times: an exploration of healthcare utilization patterns before and during COVID-19 in Iran.

Background: The COVID-19 pandemic has impacted global healthcare utilization patterns. This study aimed to examine the impact of COVID-19 pandemic on utilization rate of healthcare services in Iran.

Method: In this quasi-experimental study, data on the utilization rates of laboratory services, sonography exams, CT scans, MRIs, and EKGs was collected from the Social Security Organization (SSO)'s insurance information system. This data, covering 47 months prior to the pandemic and 25 months during it, was analyzed to assess the pandemic's impact on healthcare utilization among insured individuals in Iran. The data was categorized into direct, indirect, and total sectors, and an Interrupted Time Series Analysis (ITSA) model was employed for data analysis, examining both total and sector-specific utilization rates.

Findings: The study for single group indicated that in the total sector, Utilization rate per 1000 insured significantly decreased by 25.25 for laboratory services, decreased by 3.99 for sonography, decreased by 1.08 for MRIs and decreased by 1.01 for EKGs, but increased by 2.28 for CT scans in the first pandemic month. Over following months, monthly utilization trends per 1000 insured increased significantly- laboratory services + 1.08, sonography + 0.11, CT scans + 0.12, MRIs + 0.06, and EKGs + 0.05. Pre-pandemic, monthly utilization per 1000 insured was 62.68 labs, 14.47 sonography, 0.72 CT scans, 2.06 MRIs, with all significantly higher in the indirect over direct sector except EKGs which were 2.08 higher in the direct sector. In the first pandemic month, there were significant between-sector differences per 1000 of -4.4 for sonography, + 1.89 CT scans, -1.01 MRIs and + 1.29 EKGs.

Conclusion: The COVID-19 pandemic led to a significant decline in healthcare service utilization, particularly in total and direct sectors, while CT scans remained unaffected. To address these challenges and meet patient needs, Iran's health system should adopt alternative delivery methods like telemedicine.