The COVID-19 pandemic significantly altered individual behaviors, including the consumption of health care. I study utilization and mortality in the largest integrated health-care system in the United States, the Veterans Health Administration, and find that between the middle of March and the beginning of May 2020, emergency department and inpatient hospital visits declined by 37 percent and 46 percent, and remained 10 percent and 17 percent below expected levels by the end of October. Declines were more pronounced for nonurgent and non-life-threatening conditions, although urgent and life-threatening conditions also dropped by a quarter during the early months. Conditional on arrival at the emergency department, conditions were more severe at presentation. In the first two months of the pandemic, veteran mortality increased by 19.5 percent, yet non-COVID-19 mortality in VA inpatient settings declined. I find suggestive evidence that hospital avoidance may have resulted in higher non-COVID-19 mortality. By focusing on counties with no official COVID-19 deaths by May 19, 2020, I estimate that an upper bound of 7.9 percent of excess veteran deaths in the first two months of the pandemic were due to hospital avoidance.

中文翻译：

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COVID-19 大流行期间避免住院和意外死亡

COVID-19 大流行显着改变了个人行为，包括医疗保健的消费。我研究了美国最大的综合医疗保健系统退伍军人健康管理局的利用率和死亡率，发现在 2020 年 3 月中旬至 2020 年 5 月上旬期间，急诊科和住院就诊人数下降了 37% 和 46 %，到 10 月底仍比预期水平低 10% 和 17%。非紧急和非危及生命的情况下降更为明显，尽管紧急和危及生命的情况在最初几个月也下降了四分之一。在到达急诊室时，情况更加严峻。在大流行的前两个月，退伍军人死亡率增加了 19.5%，然而，VA 住院环境中的非 COVID-19 死亡率有所下降。我发现暗示性证据表明，避免住院可能导致更高的非 COVID-19 死亡率。通过关注到 2020 年 5 月 19 日没有官方 COVID-19 死亡的县，我估计在大流行的前两个月中，有 7.9% 的退伍军人死亡人数上限是由于避免住院。