Reduced requests for medical rehabilitation due to the SARS-CoV-2 pandemic: a difference-in-differences analysis.

Abstract

OBJECTIVE\nTo examine the extent to which medical rehabilitation requests decreased due to the pandemic in Germany.\n\n\nDESIGN\nData were retrieved from the German Pension Insurance which is the main provider for rehabilitation of working-aged people in Germany. Our data represented all medical rehabilitation requests in 2019 and 2020. These requests have to be approved to use a rehabilitation program. We used a difference-in-differences model to determine the reduction in rehabilitation requests attributable to the pandemic.\n\n\nSETTING\nGeneral community PARTICIPANTS: We included 1,621,840 rehabilitation requests from working-aged people across Germany in 2019 and 1,391,642 rehabilitation requests in 2020.\n\n\nINTERVENTION\nMedical rehabilitation in inpatient or outpatient facilities MAIN OUTCOME MEASURE: Number of medical rehabilitation requests RESULTS: The number of medical rehabilitation requests decreased by 14.5% due to the pandemic (incidence rate ratio, IRR\u202f=\u202f0.855; 95% CI: 0.851 to 0.859). The decline in requests was more pronounced among women and in Western Germany than among men and in Eastern Germany. The reduction in requests affected non-post-acute rehabilitations more clearly than post-acute rehabilitation services. After the pandemic declaration by the German Bundestag in March 2020, the reduction in requests was initially strongly associated with the regional incidence of infection. This association weakened in the following months.\n\n\nCONCLUSION\nThe reduction in requests will have a significant impact on the number of completed rehabilitation services. For many people with chronic diseases, failure to provide medical rehabilitation increases the risk of disease progression.