Negative effects of high public debt on health systems facing pandemic crisis: Lessons from COVID-19 in Europe to prepare for future emergencies

Mario Coccia; Igor Benati; Mario Coccia; Igor Benati

doi:10.3934/publichealth.2024024

AIMS Public Health

2024, Volume 11, Issue 2: 477-498. doi: 10.3934/publichealth.2024024

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Research article

Negative effects of high public debt on health systems facing pandemic crisis: Lessons from COVID-19 in Europe to prepare for future emergencies

Mario Coccia ^,,
Igor Benati

CNR – National Research Council of Italy, Department of Social Science and Humanities, IRCRES, Torino, Italy

Received: 22 September 2023 Revised: 13 March 2024 Accepted: 19 March 2024 Published: 11 April 2024

The investigation goal here was to analyze how the level of public debt affects preparedness of health systems to face emergencies. In particular, this study examined the negative effects of high public debt on health systems of European countries in the presence of the COVID-19 pandemic crisis. Empirical evidence revealed that European countries with a lower level of government debt as a percentage of GDP both in 2009 and 2019 (the period before the arrival of the pandemic) had lower COVID-19 fatality rates compared to countries with higher levels of public debt. The explanation is that high levels of public debt in countries trigger budget constraints that limit their ability to allocate resources to healthcare systems (e.g., health expenditures and investments), weakening health system performance and causing systemic vulnerability and lower preparedness during emergencies, such as with the COVID-19 pandemic. Implications of health policies are suggested to improve strategies of crisis management.
- COVID-19,
- government debt,
- crisis management,
- preparedness,
- systemic vulnerability,
- public health,
- public health governance,
- pandemic crisis,
- Europe
Citation: Mario Coccia, Igor Benati. Negative effects of high public debt on health systems facing pandemic crisis: Lessons from COVID-19 in Europe to prepare for future emergencies[J]. AIMS Public Health, 2024, 11(2): 477-498. doi: 10.3934/publichealth.2024024

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Abstract

The investigation goal here was to analyze how the level of public debt affects preparedness of health systems to face emergencies. In particular, this study examined the negative effects of high public debt on health systems of European countries in the presence of the COVID-19 pandemic crisis. Empirical evidence revealed that European countries with a lower level of government debt as a percentage of GDP both in 2009 and 2019 (the period before the arrival of the pandemic) had lower COVID-19 fatality rates compared to countries with higher levels of public debt. The explanation is that high levels of public debt in countries trigger budget constraints that limit their ability to allocate resources to healthcare systems (e.g., health expenditures and investments), weakening health system performance and causing systemic vulnerability and lower preparedness during emergencies, such as with the COVID-19 pandemic. Implications of health policies are suggested to improve strategies of crisis management.

Acknowledgments

This study is not funded by any agency and is being conducted by the authors independently. Sources of data are Eurostat [97],[98], JHU [99], and WHO [100] (cf., [101]).

Conflict of interest

Mario Coccia is an editorial board member for AIMS Public Health and was not involved in the editorial review or the decision to publish this article. All authors declare that there are no competing interests.

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