HEALTHCARE ECONOMICS 

THE IMPACT OF COVID-19 ON HEALTHCARE INEQUITIES:- Assessing the long-term Economic consequences on Vulnerable Population

By:-

Sheetal 

Ayush Burnwal

Zaheen Qureshi

Sanjula D

Pankhudi Jha

INTRODUCTION

The first whispers about an obscure virus were heard in Wuhan, China. A few months later, it began to spread, accompanying the number of cases contaminated rising swiftly and comprehensively in domains of the world for fear that on March 11, 2020, the WHO regularly announced the new affliction as a worldwide universal. The disease has a development ending from two to fourteen days but generally remains asymptomatic. If indicative, the universal signs and symptoms noticed include turmoil, dry cough, shortness of whiff, proneness, neck sensitivity, restlessness, and in harsh cases leads to severe respiratory distress syndrome and pneumonia that in decay can finish in multiple means of loss and certainly death. The harsh performance of affliction was majorly seen in toddlers and aging old people. Many measures were taken to stop the affliction i.e. seclusion, quarantine of distrust, tight infection administration conduct, contact security measures, and social passing. 

In reference to this healthcare inequities may be delimited as differences in healthcare rank or the disposal of well-being resources between various populace groups, arising from public environments at which point people are innate, evolve, live, work, and age. Health inequities are prejudiced and could be weakened for one right join of government tactics. A big culture, variations in possessions across domains, and a feeble community health system in India formal a challenge in conditions of momentary and preparedness to handle a quickening caseload.16 In conditions of available capital, from the 3.6% GDP expense in healthcare, only 1.5% is apiece Government, and households carry more than 2%, that is to say, 65% of payment is out of pocket.12 The system working, when COVID hit, was accordingly underprepared to deal with this crisis.

The risk of harsh complexities from COVID-19 is higher for certain unsafe people, particularly the ones who are retired, frail, or have diversified never-ending environments. The other susceptible group is made apiece stranded, weak, regular traders as the ever-growing strength cost keeps aggressive those just above the poverty line back into want. Vulnerable societies were individual big groups in India, labeled all along COVID.

OBJECTIVE 

To examine healthcare inequities from a multidimensional lens of economics, in the aftermath of COVID-19. 

HEALTHCARE INEQUITIES

India however confronts many difficulties in providing equitable healthcare to all due to its large population. Healthcare inequities are influenced by a number of factors such as socioeconomic status, regional differences, inadequate healthcare facilities, gender stereotypes, etc. These inequities produce systematic disadvantages and cause disparities among different sections of the population.

The rural population often prefers public health because it provides them with the most accessible and affordable healthcare option, as they typically lack the financial means to access private healthcare services, which are often more expensive and may not be readily available in their communities. It is, therefore, the public health system that serves the majority of India’s vulnerable rural population. Nearly 75 percent of health-related infrastructure, medical workforce, and other health resources are concentrated in urban areas, where only 27 percent of the population resides. This leaves the poorest segments of the population in rural areas facing numerous access barriers. 

Providing well-equipped public healthcare becomes quintessential in reducing inequities between the rural and the urban. It is therefore important to have a strong and effective public healthcare system as the rural population’s access to basic health services is mainly through primary healthcare centers which is widely regarded as the most inclusive, equitable, and cost-effective way to achieve universal health coverage. PHCs in India are understaffed as more than 37% of the health assistant positions, 34% of laboratory staff and 21% of nurse positions are vacant. There is widespread absenteeism among healthcare workers in PHCs. Due to poor management and ill-equipped services provided by PHCs, the rural population is forced to seek services from the private sector, causing more financial complications and widening the rural-urban gap.

One of the main challenges is that health spending in India is mostly out-of-pocket. OOP health expenditure imposes an extreme financial burden on households because the fees and cost of treatment are very high in private facilities and unaffordable for people earning low incomes. OOP expenditure on health is one of the biggest reasons for people falling into poverty in India.

Nearly 70% of hospitals and 40% of hospital beds are private. Health insurance is largely private, and the urban poor cannot afford private care. The Indian healthcare budget is inadequate; the total healthcare expenditure was at only 1.3% of gross domestic product in 2021, which is the lowest in the BRICS group. There is a disparity in the availability of infrastructure and resources between rural and urban areas in India. Evidence points out that among all health workers, 67% were serving in urban areas where 33% of the population is based; and 33% were serving in rural areas where 67% of the population resides. India has approximately 860 beds/million population as compared to WHO’s estimate of the world average, which is 3,960 beds/million population, proving that our healthcare infrastructure is seriously lacking. 

Gender stereotypes and inequalities can also impact access to healthcare, particularly for women. Cultural norms may limit women’s autonomy in making health decisions, leading to delays in seeking care or requiring approval from male family members. Additionally, gender-based discrimination and violence can further hinder women’s access to medical services. Women and elderly patients often rely on family support to reach healthcare facilities and may need permission before spending money on treatment, taking tests, or attending follow-up appointments.

India is a major hub for private health tourism. Private hospitals in India are seeing an influx of patients. India ranks among the top 20 countries in terms of private expenditure on health in percent GDP terms – around 4.5-5 percent of GDP. The extra revenue from medical tourism could benefit healthcare in India if it were taxed adequately to support public health. Instead, the medical tourism industry is provided tax concessions; the government gives private hospitals treating foreign patients benefits such as lower import duties. Despite significant progress in the country’s private healthcare system, equitable access to basic healthcare services remains a paramount concern, particularly for approximately 70 percent of the population outside metropolitan cities. 

CAUSES OF INEQUITIES

Diving deeper into the causes of the inequities, it can be noted that the pandemic has only exacerbated the pre-existing inequalities. Taking data into consideration, the Urban-Rural divide played a major role in healthcare inequality. Despite India having a rural background of 65% (2021), the concentration of healthcare is only 20-30% while the urban areas boast 70-80% of the total infrastructure. Study shows that although one-third of the villages in India have a good specialized hospital within 5 km, the other two-thirds have a specialized hospital within 16 km or more. The main reason for the distribution of the facilities is that the private sector is the major player compared to the government. Cities having higher middle-income and rich populations hold more infrastructure than their rural counterparts.

Whereas the wealth or the income divide among the people has been increasing the inequality of access. Even though the same quality of healthcare facilities is available to the urban population at a lesser cost, it comes at a higher price for the rural population. The lack of good healthcare facilities results in rural populations being burdened with crippling costs which pushes them back to poverty. It is found that around 24.9% of rural households reported their major source of hospitalization expenditure as borrowings; this particularly shows the poor conditions of penetration of insurance and cheaper healthcare in rural areas.

CURRENT STATUS OF HEALTHCARE ECONOMICS

In response to the pandemic, the Government’s healthcare expenditure increased from 1.3% in 2019 to 1.8% in 2023, with a target of 2.5% by 2025. Initiatives like Ayushman Bharat Yojna expanded to provide broader coverage and treatment. Moreover, massive investments are taking place for providing in-minute or digital healthcare security to each citizen.

However, significant challenges persist. Indian healthcare is still struggling with underfunding and a shortage of medical professionals, particularly in rural areas. India is still behind the WHO-recommended doctor-to-patient ratio, which is one doctor per thousand population. Additionally, a study shows only around 14% of the rural population was covered by health insurance wherein the low disposable income is a contributing factor that prevents people from accessing healthcare facilities. Hence, it can be concluded that despite the efforts of the government, the healthcare sector requires a revolution in terms of providing access and availability to the citizens.

ECONOMIC CONSEQUENCES ON VULNERABLE POPULATION

The pandemic projected the reality of the Indian healthcare system. Although the immediate health crisis was tackled by the government, it continued to affect the nation, aggravating the existing vulnerabilities. One of the most significant consequences stems from the unequal access to healthcare. The rural population and the marginalized sections, particularly the daily wage earners and the informal sector workers suffered the most due to limited access to quality healthcare, poor living conditions, and pre-existing inequities, leading to a rise in morbidity and mortality rates among the poor which led to a substantial loss of productive workforce and low income. These people were pushed further into poverty, depleting their savings and forcing them to take on increased debts. In the absence of social safety nets, it created a vicious cycle of poverty and hampered human capital development.

The pandemic also exposed the condition of Indian public healthcare infrastructure. The concentration of healthcare resources in urban areas meant that the rural population faced the disproportionate burden of illness and mortality as private healthcare services were expensive. This delayed diagnosis and treatment and the mental health crisis triggered by the pandemic added further to the crisis. The pandemic highlighted the regional disparities in healthcare services. States with weaker healthcare systems and higher poverty rates experienced greater economic hardships which created a challenge for balanced economic development.

It also underestimated the gendered impact of healthcare inequities. Women, being the primary caretaker of the household, faced increased burdens during the pandemic. Limited access to maternal healthcare and family planning services added to it, leading to their reduced workforce participation hampering women’s empowerment and economic development.

RESULTS

COVID-19 was a phenomenon that shook the foundation of our economic system, leaving lasting repercussions across nations. The crisis laid bare the fragility of the healthcare system, particularly in countries with minimal increases in healthcare expenditure and gradual commercialization of the system. Accordingly, the marginalized communities including caste minorities and gender minorities, which are at the bottom of the ladder, experienced inadequate access to quality healthcare. 

In 2021 alone, the pandemic drove approximately 4.7 million individuals into extreme poverty and led to the loss of a staggering 9.3 million jobs in these countries. Moreover, it increased social tensions, fueled xenophobia, and highlighted the need for better mental health services. Low-income countries were primarily affected by disruptions in the supply chain and tourism losses. This affected local economies, impacting informal workers and small businesses. This is an example of healthcare economics overfocusing more on the profit and market model, neglecting the evident inequality.

India within the broader area of the South Asia region, grappled with economic, political, and social difficulties. The private healthcare expenditure was at the highest in the year 2020 at 37.20%. This reliance on private funding has exacerbated out-of-pocket expenses, which is a major factor in pushing people to poverty. Moreover, the rural-urban gap is widening due to the underfunding of the public system.

In conclusion, COVID-19 has exposed healthcare inequities deeply entrenched in the system. The inequity in accessibility for Indigenous people, caste minorities, and other marginalized groups is a grave concern that should be highlighted and worked on. Systemic inequities and social discrimination lead to economic vulnerabilities. 

SOLUTION

Universal healthcare is the aim of most countries, and the Indian government has launched different schemes in support of it such as the PMJDY initiative. However, significant gaps remain, such as inequitable supply and utilization, which contribute to unequal access to healthcare (Dubey et al. 2023). To address these shortfalls, an increase in government health expenditure is crucial for achieving the development goals. 

Expanding investment in training, developing skills, and hiring healthcare workers along with increased research can help in economic growth. Shifting the limelight on high pharmaceutical profits and redirecting it towards improvement in primary health care centers in rural areas is crucial. Establishing community-based monitoring systems and a patient’s rights charter will form the basis of the improvement of healthcare as a human right. Implementing welfare-oriented policies focused on the disadvantaged will reduce their financial burden, making medical expenses accessible. Additionally, incorporating inequity discussions in global policy debates is important for systemic change. 

The pandemic’s economic fallout-marked by job losses and financial instability has had enduring impacts. It is a wake-up call for inclusive and equitable development policies.

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