COVID-19 and Sustainable Healthcare Systems

Author: Lorcan Clarke

The ongoing COVID-19 outbreak will likely continue through 2020 and into 2021, with governments rapidly accelerating into health and economic responses that are of unprecedented scale in modern peacetime.

The scale of responses to COVID-19 and their consequences, both for health systems and economies, mean that proactive action by the research community will be critical to alleviate future pressures on health systems and ensure services remain high-quality, accessible, and sustainable. These pressures will centre on the demand and supply of healthcare services.

  • Demands on healthcare services, beyond COVID-19 itself, will increase in at least two ways – forgone care and burden of non-communicable diseases (NCDs).

Forgone care may arise due to individuals being unable to access prescription treatments, personal consultations, or physical supports (e.g. physiotherapy). An increased burden of NCDs may arise because of the spillover effects of COVID-19 and interventions to mitigate the outbreak (e.g. social isolation, job losses and strain on social networks).

Demand side interventions are critical because they will help better alleviate burdens on available healthcare resources, which will likely come under severe pressure without proactive political intervention.

  • Supply of healthcare services will decrease in at least two ways – lost capacity and insufficient investments

 COVID-19 has already led to the redeployment of healthcare service resources in many countries. It is likely that this will be followed by a short-term reduction in the availability of human resources for health, due to disease risks and job stresses. In the short to medium term, it is also likely that absolute government spending on healthcare services will fall. This is due to the inevitable decrease in government tax revenues, associated with economic disruption; and increased debt service requirements, associated with the use of unprecedented economic support measures in many countries (e.g. salary supplementation schemes and liquidity support for companies) which may require large-scale sovereign debt financing.

Supply side actions and strategies are critical because they will help expand the potential impact of available healthcare resources, which will likely be constrained in the short to medium term without proactive political intervention.

  • Researchers can help support the short to medium term sustainability of healthcare services in at least two ways – identify how to mitigate expected increases in demand on healthcare systems and identify how to minimise the impact of expected decreases in the supply of financial and non-financial resources available to healthcare systems.

Existing research that can help mitigate the impacts of forgone care may include individual-level interventions which provide access to remote services (e.g. GP consultations) and systems-level interventions which ensure access to medicines and other consumables (e.g. last-mile supply chain interventions). Existing research that can help mitigate the impacts of an increased burdens of NCDs might include identifying early stage interventions which can prevent NCDs, under current constraints, and later stage interventions which can be applied with a high impact after COVID-19 mitigation measures are lifted (e.g. social isolation). Research on interventions should be complemented by investigations into risk factors and potential disease progression.

Existing research should be identified that can support the delivery of interventions that maximise the impact of available resources and identify areas where costs can be reduced with the minimum possible impact. This will include identifying cost-effective interventions, actions and strategies, which offer good value for money, and efficient interventions, actions and strategies, even those which may be comparatively less effective, that open up resources to be used in cost-effective ways elsewhere.


Reliable data on the size of the demand and on supply side interventions, actions and strategies will help ensure that the short to medium term shocks associated with COVID-19 do not ripple over time. Left unabated, such ripples will cause even more substantial excess deaths due to inaccessible and poor quality healthcare and create fragility in healthcare systems that could have serious implications for the next time a health emergency or disasters occurs. New research should be conducted to add to the current evidence base on these issues and the evidence base should be brought together in evidence syntheses.

Lorcan is an economist focused on improving health systems and increasing resilience to emergencies and disasters.

Twitter: @lorcan_clarke