Page 143 - GHES-3-3

Global Health Economics and
Sustainability

ORIGINAL RESEARCH ARTICLE
Health expenditure and fiscal marksmanship

before and during the coronavirus pandemic
across the federal states of India

Mihajlo Jakovljevic 1,2,3 , Pragyan Monalisa Sahoo * , and
4
Himanshu Sekhar Rout *
4,5
1 UNESCO-TWAS The World Academy of Sciences, Strada Costiera 11, Trieste, Italy
2 Shaanxi University of Technology, Hanzhong, Hantai, China
3 Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, Serbia
4 Department of Analytical and Applied Economics, Utkal University, Vani Vihar, Bhubaneswar,
Odisha, India
5 RUSA Centre of Excellence in Public Policy and Governance, Utkal University, Vani Vihar,
Bhubaneswar, Odisha, India
(This article belongs to the Special Issue: Sustainable Healthcare in the Emerging BRICS+ Markets)

Abstract

This study examined state-level health expenditure, fiscal marksmanship, and
COVID-19 deaths among selected states in India. It (1) compared health expenditure
*Corresponding authors: between the pre-COVID-19 and the COVID-19 period in India and selected states;
Himanshu Sekhar Rout (2) investigated the fiscal marksmanship in the context of health expenditure at
(hsrout@utkaluniversity.ac.in)
Pragyan Monalisa Sahoo the national and state level; and (3) assessed the relationship between COVID-19
(pragyan@utkaluniversity.ac.in) deaths, population density, health expenditure, and fiscal marksmanship. The study
Citation: Jakovljevic, M., period from 2017 to 2021 was divided into pre-COVID-19 (2017-late – 2019) and
Sahoo, P.M., & Rout, H.S. (2025). COVID-19 (late-2019 – 2021). This study focused on India and selected Indian states,
Health expenditure and fiscal using data from state budget documents, Census 2011 for population density, and
marksmanship before and during
the coronavirus pandemic across COVID-19 data from the government website. Descriptive statistics, percentages,
the federal states of India. Global ratios, graphs, and tools such as Theil’s U-Statistic and Pearson’s correlation were
Health Econ Sustain, 3(3):135-149. employed for analysis. Simple linear regression was used to analyze the impact of
https://doi.org/10.36922/ghes.2920
fiscal marksmanship and other variables on the case fatality ratio. This study revealed
Received: February 12, 2024 challenges in maintaining fiscal discipline during COVID-19, with disparities in
Revised: March 22, 2024 capital expenditure among states. The results emphasized the need for increased
health spending and structural changes to enhance resilience to future health crises,
Accepted: May 10, 2024
advocating for investments in infrastructure and services to improve preparedness.
Published online: October 18, 2024
Copyright: © 2024 Author(s). Keywords: Health expenditure; COVID-19; Fiscal marksmanship; India; Federal states
This is an Open-Access article
distributed under the terms of the
Creative Commons Attribution
License, permitting distribution,
and reproduction in any medium, 1. Introduction
provided the original work is
properly cited. The COVID-19 pandemic has had a multifaceted impact on countries, including
Publisher’s Note: AccScience economic, social, political, and health aspects (Shang et al., 2021; Park et al., 2020;
Publishing remains neutral with Shadmi et al., 2020; Šteinbuka et al., 2022); however, discussions have predominantly
regard to jurisdictional claims in
published maps and institutional centered on its health and economic ramifications (Dutta & Fischer, 2021; Lal et al.,
affiliations. 2021; Loayza, 2020; Roberton et al., 2020). Governmental health expenditures and

Volume 3 Issue 3 (2025) 135 https://doi.org/10.36922/ghes.2920