Health expenditure and fiscal marksmanship before and during the coronavirus pandemic across the federal states of India

This study examined state-level health expenditure, fiscal marksmanship, and COVID-19 deaths among selected states in India. It (1) compared health expenditure between the pre-COVID-19 and the COVID-19 period in India and selected states; (2) investigated the fiscal marksmanship in the context of health expenditure at the national and state level; and (3) assessed the relationship between COVID-19 deaths, population density, health expenditure, and fiscal marksmanship. The study period from 2017 to 2021 was divided into pre-COVID-19 (2017-late – 2019) and COVID-19 (late-2019 – 2021). This study focused on India and selected Indian states, using data from state budget documents, Census 2011 for population density, and COVID-19 data from the government website. Descriptive statistics, percentages, ratios, graphs, and tools such as Theil’s U-Statistic and Pearson’s correlation were employed for analysis. Simple linear regression was used to analyze the impact of fiscal marksmanship and other variables on the case fatality ratio. This study revealed challenges in maintaining fiscal discipline during COVID-19, with disparities in capital expenditure among states. The results emphasized the need for increased health spending and structural changes to enhance resilience to future health crises, advocating for investments in infrastructure and services to improve preparedness.