Lingering Effects on the Ecology of Medical Care After the COVID-19 Pandemic: A Nationwide Repeated Cross-Sectional Study in Japan.

Background: Previous studies have examined short-term changes in health care utilization during the COVID-19 pandemic, but research on long-term post-pandemic effects remains limited. We aimed to evaluate health care utilization after the pandemic based on the ecology of medical care model and to compare it with the results before and during the pandemic in Japan. Methods: We conducted a nationwide repeated cross-sectional survey of a representative sample of the general Japanese adult population in 2021 and 2024. The main outcomes were health care utilization for new health problems. We estimated the number of each health care utilization per 1000 population per month and compared it with the previous study conducted before the pandemic. Results: Data from a total of 2992 participants were analyzed. Visits to physicians' offices that primarily provide primary care declined during the pandemic and increased after the pandemic, but have not fully recovered to pre-pandemic levels. The recovery in physician's office visits between during and after the pandemic tended to be smaller among younger adults, females, those with lower education levels, those with higher incomes, and those without chronic conditions. On the other hand, emergency room visits, which declined during the pandemic, increased to higher levels than before the pandemic. Conclusions: Primary care utilization has not recovered to pre-pandemic levels, while emergency room visits have increased to higher levels than before the pandemic. Understanding long-term changes in health care utilization behaviors after the pandemic can help policymakers strengthen primary care systems.