The impact of public discourse on healthcare utilization during the COVID-19 pandemic

Abstract The COVID-19 pandemic disrupted healthcare systems worldwide, leading to substantial declines in preventive service utilization. We examine whether public discourse about COVID-19, measured as sentiment and topic salience on Twitter and in German newspapers, was associated with healthcare utilization in Germany between 2020 and 2022. Using computational text analysis and fixed-effects panel regressions of administrative outpatient data, we link monthly discourse measures from national and regional newspapers, Bild, and geolocated Twitter posts to utilization changes across screenings, vaccinations, chronic care, and psychotherapy. More positive sentiment and higher COVID salience were generally associated with lower use of discretionary services such as cancer screenings and group psychotherapy. By contrast, influenza and pneumococcal vaccination uptake increased when COVID-related attention was higher, particularly on Twitter and in Bild. Associations varied by media source, indicating that salience and evaluative tone capture distinct aspects of the information environment that relate differently to healthcare behavior.