Changes in Children's Health Care Access and Utilization in the United States in the First 2 Years of the COVID-19 Pandemic

OBJECTIVE: To compare children's access to and utilization of health care services in the United States during the first 2 years of the pandemic to prepandemic levels.METHODS: This cross-sectional study used data from the 2017 to 2021 National Survey of Children's Health. Access to care was measured by having a usual place for sick and preventive care, having a personal doctor or nurse, and unmet care needs. Utilization measures included preventive, mental health, specialist, and emergency department (ED) visits, and hospital admissions in the past 12 months. Outcomes were reported by parents or other caregivers. Multivariate logistic regressions were employed adjusting for sociodemographic factors and state of residence. The study sample included 163,353 children aged 0 to 17 years. RESULTS: Compared to 2019, there were declines in the probability of having a usual place for sick care in 2020 (- 1.5 percentage-points) and a usual place for preventive care in 2021 (- 2.1 percentage-points), and greater probability of unmet care needs in 2020 (+ 1.2 percentage-points) and 2021 (+ 0.8 percentage-points). The probability of having any preventive, specialist, and ED visits and hospitalizations remained lower in 2021 than 2019 (- 7.5, 2.2, 5.4 and 0.9 percentage points, respectively). These differences were not explained by prepandemic trends and were observed across a range of sociodemographic subgroups.CONCLUSIONS: Children's health care access and utilization declined noticeably over the first 2 years of the pandemic. Evaluating these outcomes in subsequent years and addressing barriers to care continue to be critical to reduce unmet needs.