Are State Healthcare Budgets a good predictor of COVID-19 response?

COVID-19 has exposed the healthcare response of many States and probably brought to the fore some states that have done quite well. One of the big arguments was that if States spend more money and time on healthcare, we would be better off when it comes to COVID-19. Today we explore this topic and check if indeed there was some linkage.

Source: RBI and Census

Amongst the more affluent States, Delhi is way ahead while amongst the Poor States, Assam and Chhattisgarh are ahead. This is something Arvind Kejriwal has made a critical point in Delhi.

Source: RBI, Census

Contrary to what many think, poor States actually spend a lot more (as % of GDP) on healthcare than affluent States. Delhi contrary to what many think looks like it spends a lot but when its GDP per capita is taken into account, Kerala and Uttarakhand stand out as well. Amongst the Poor States, Assam and Chhattisgarh Stand out clearly


One reason why Poor States spend more is because their citizens depend much more on Public healthcare. In the more affluent States, dependence on Government healthcare is lower. But there are some standouts. TN dependence on Public healthcare is high but its spends are low. Same with Karnataka. Uttarakhand and Delhi appear to be spending much but dependence on Government healthcare is high.

Kerala is exceptional because not only is the private sector dependence high, the spends on Govt healthcare is also one of the highest amongst affluent States.

When it comes to COVID performance, the worst performing States (in Red) are spread all over the place. There are some rich States and there are some Poor States. There are small States and there are big States.

The Same Holds true with Niti Aayog’s Healthcare SDG rank

Source: Niti Aayog, SGD Index

What the data seems to suggest is that just spending more or getting basic metrics right is NOT a good predictor of how a State responds to Pandemics. In fact, a simple study of Mumbai city and how some Wards seem to be doing better than other Wards indicate other factors that can play a decisive role – Community Organising and Local Government leadership are as important to pandemic response as access or even quality of healthcare. Which also explains why Bangalore is doing way better than most Metros.