Reduced Requests for Medical Rehabilitation Because of the SARS-CoV-2 Pandemic: A Difference-in-Differences Analysis

Objective: To examine the extent to which medical rehabilitation requests decreased because of the pandemic in Germany. Design: Data were retrieved from the German Pension Insurance, which is the main provider for rehabilitation of working-age 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. Setting: General community. Participants: We included 1,621,840 rehabilitation requests from working-age people across Germany in 2019 and 1,391,642 rehabilitation requests in 2020 (N=3,013,482). Intervention: Medical rehabilitation in inpatient or outpatient facilities. Main Outcome Measures: Number of medical rehabilitation requests. Results: The number of medical rehabilitation requests decreased by 14.5% because of the pandemic (incidence rate ratio, 0.855; 95% confidence interval, 0.851-0.859). 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-postacute rehabilitations more clearly than postacute 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. Conclusions: The reduction in requests will have a significant effect on the number of completed rehabilitation services. For many people with chronic diseases, failure to provide medical rehabilitation increases the risk of disease progression.