Page 153 - GHES-3-3

Global Health Economics and
Sustainability
A comparative analysis

et al., 2022), and states maintaining consistently high health expenditure, jeopardizing their fiscal sustainability
health spending throughout COVID-19 saw limited (Gupta & Sala, 2022; Rajabi et al., 2022; Wang et al., 2022;
positive effects on CFR. This outcome aligns with Luong’s González-Bustamante, 2021; Maher et al., 2020).
(2020) findings, indicating that an increased GDP share of These instances of pandemic-induced fiscal challenges,
total health expenditures can reduce CFR; however, this both in India and globally, indicate gaps in the readiness of
situation failed to explain CFR changes despite notable health systems for crises (Cylus & Pearson, 2015; Sebastian
deviations in fiscal marksmanship, particularly in capital et al., 2021). These gaps highlight the necessity for increased
expenditure. Research by Vysochyna and Kwilinski (2023) healthcare funding and a fundamental restructuring of
on European countries supports our findings, highlighting public health expenditure (Kwon & Kim, 2021; Jakovljevic,
the dominance of current health expenditure over capital 2014). Assessing the impact of public health expenditure
expenditure in explaining health outcomes.
on pandemic preparedness should consider traditional
The urgent surge in capital expenditure during measures, like total health expenditure as a share of the
COVID-19 underscores infrastructure inadequacies and domestic product, and new indicators, such as adaptive
systemic unpreparedness, highlighting that fiscal discipline health system (Sundararaman et al., 2021; UN, 2020),
depends on effective regulation and preparedness for time-responsive pandemic schemes, and efficient resource
health emergencies, preventing increased expenditure allocation (Forman et al., 2022; Chowdhury and Jomo,
in unforeseen circumstances. The occurrence of actual 2020; Sparkes et al., 2019). As suggested by Eissa (2020),
expenditure surpassing the budgeted amount during crises integrating sustainable development goals becomes crucial
highlights the inadequacy of expenditures to strengthen in evaluating the effectiveness of public health expenditure
the health system. Such insufficiency contributes to the in addressing pandemic crises.
national health system being overburdened during critical
periods, leading to its potential breakdown. 5. Conclusion
The substantial increase in health expenditure during This analysis presented a comprehensive examination of
the pandemic and pre-existing economic challenges health expenditure and fiscal responsibility during the pre-
(Keshavarzi et al., 2023; Pillai et al., 2020) limited the COVID-19 and COVID-19 periods at the national and
central government’s fiscal capacity. Consequently, central sub-national levels. The findings underscored that states
and state authorities exercised prudence to avoid excessive encountered challenges in maintaining fiscal discipline,
debt accumulation. Their predominant response involved particularly during the COVID-19 period, where notable
implementing measures to enhance liquidity, coupled disparities in capital expenditure occurred.
with some fiscal initiatives targeted at the most vulnerable This assessment provides valuable insights into the
segments of the population (Jose et al., 2021; Chudik et al., ongoing discourse on enhancing fiscal resilience and
2021).
preparedness in the face of global health crises. The
India was not the only country that faced fiscal study’s findings on fiscal marksmanship highlight that the
challenges during the pandemic; developed nations in current health spending in India cannot address another
the Global North experienced similar issues (Ghaffari health crisis similar to COVID-19. The proportion of
Darab et al., 2021; González-Bustamante et al., 2021; government health expenditure in total health spending in
Šteinbuka et al., 2022). For example, Cho et al. (2020) India has remained small for an extended period despite
examined France’s response to COVID-19, revealing that governmental efforts and promises to increase it.
the government initially underestimated the impact of Policy interventions should address underfunding in
the crisis on the state budget due to the health situation
and a substantial economic shock. The strong budgetary the health sector to ensure adequate resource allocation
constraint initially made the government hesitant to and improve health outcomes, especially during crises
like the COVID-19 pandemic. Increasing total health
spend significantly, leading to abrupt, forced spending expenditure, accompanied by necessary structural changes
later. Zahariev et al. (2021) extended this analysis to the in health expenditure components and allocations to
entire EU, identifying a significant impact of COVID-
19 on the EU’s fiscal sustainability. From the long-term enhance efficiency, may prevent fiscal overburden during
perspective, the fiscal sustainability of Eastern Europe crises.
remains far more dependent on Eurasian integration Fiscal indiscipline may not have a negative long-
efforts and massive trade routes connecting Europe and term impact, particularly on health outcomes. Private
Asia (Jakovljevic et al., 2020). Developing nations and their spending meeting current needs can explain this situation.
developed counterparts encountered a significant surge in However, in the long run, government health expenditure

Volume 3 Issue 3 (2025) 145 https://doi.org/10.36922/ghes.2920