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Novel Coronavirus – 19 Pandemic Impact
On Private Health‑Care Services with
Special Focus on Factors Determining Its
Utilization: Indian Scenario
Website:
www.ijhas.in Sathish Raju Nilakantam, M Kishor1, M Dayananda, Amogha Shree2
DOI:
10.4103/ijhas.IJHAS_69_20
Abstract:
The novel coronavirus disease (COVID‑19) outbreak, caused by severe acute respiratory syndrome
coronavirus 2, has rapidly escalated into a global pandemic which leads to declaration of national
health emergency in several countries and is having a profound impact on private health‑care systems
globally including India in unprecedented manner. However, the impacts are very serious, especially
on global economics and health care due to COVID‑19 pandemic. During this pandemic, private
hospitals and clinics are experiencing a reduction of in patient footfalls due to nationwide lockdown
and several other factors as well which are leading to inadequate utilization of health‑care services
by the patients and decrease in medical services volumes which resulted in acute economic crisis. In
this article, various factors that caused a significant reduction in utilization rates of private health‑care
systems such as hospitals and clinics were outlined and discussed.
Keywords:
COVID‑19, novel coronavirus, pandemic, private health‑care systems

Introduction people, their businesses, and problem

in getting their essentials and even the

T he World Health Organization declared

COVID‑19 infection as a global pandemic
which is presently engulfing 213 countries
health‑care sector largely. COVID‑19
has affected the entire departments in
the hospital where they are unable to
affecting over 2 million people and 157,970 concentrate on their regular patients.
deaths as of April 20, 2020.[1] It is expected
that the number will grow in the next The central and the state governments
Departments of Hospital
Administration, 1Psychiatry few weeks. India is also suffering with across the nation enlisted almost all district
and 2Community Medicine, over  17,000  cases and nearly 550 deaths government hospitals for the identification
JSS Medical College and as of April 20, 2020. [2] Being one of the and management of COVID‑19 in the initial
Hospital, JSS Academy phase. The private health‑care systems
developing countries, India is suffering with
of Higher Education
and Research, Mysore, humanitarian crisis with severe restriction consist of 58% of the hospitals in the country,
Karnataka, India on people’s movement like complete 29% of beds in hospitals, and 81% of doctors,
lockdown that predominantly affected which account for 82% of outpatient visits,
Address for millions of migrant workers and daily wage 58% of inpatient expenditure, and 40% of
correspondence:
Dr. Amogha Shree, workers.[3] births in institutions.[4] Hence, it is important
Department of Community to understand the determinants of hospital
Medicine, JSS Medical This worldwide COVID‑19 infection has service utilization during COVID‑19
College and Hospital, also affected the day‑to‑day life of the specifically for the private hospitals not
JSS Academy of Higher
Education and Research,
only because they are major contributors to
Mysore, Karnataka, India. This is an open access journal, and articles are
E‑mail: amoghashree@ distributed under the terms of the Creative Commons
jssuni.edu.in Attribution‑NonCommercial‑ShareAlike 4.0 License, which How to cite this article: Nilakantam SR, Kishor M,
allows others to remix, tweak, and build upon the work Dayananda M, Shree A. Novel coronavirus – 19
Received: 29‑04‑2020 non‑commercially, as long as appropriate credit is given and pandemic impact on private health‑care services with
Revised: 02‑05‑2020 the new creations are licensed under the identical terms. special focus on factors determining its utilization:
Accepted: 12‑05‑2020 Indian scenario. Int J Health Allied Sci 2020;9:S77-80.
Published: 04-06-2020 For reprints contact: reprints@medknow.com

© 2020 International Journal of Health & Allied Sciences | Published by Wolters Kluwer ‑ Medknow S77
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Nilakantam, et al.: Novel Coronavirus – 19 Pandemic Impact On Private Health‑Care Services with Special Focus on Factors Determining Its
Utilization: Indian Scenario
the health‑care delivery system in India but also due to a
fact that some private hospitals continued to serve in the
middle of COVID‑19 crisis for non‑COVID‑19 patients.
Few private hospitals were also shut down during the
pandemic times, due to the high rate of infections in those
hospitals. The probable reason could be due to the early
phases of pandemic, where hospitals were not prepared
to identify and manage effectively and also due to lack of
experience of hospital staffs in dealing with such a novel
agent and with such a degree of infectivity. According to
the National Family Health Survey‑3, the private medical
sector remains the primary source of health care for 70%
of households in urban areas and 63% of households in
rural areas.
The health‑care sector is at the epicenter of this
unprecedented global pandemic challenge, and the
private health sector has risen to the occasion, by offering
to the government all the support it needs, be it testing
support, preparing isolation beds for the treatment of
COVID‑19‑positive patients, or deploying equipment
and staff in identified nodal hospitals.
As the lockdown began, the government at all levels
repeatedly highlighted the fact that health‑care services
come under essential services and hence shall be
exempted. However, there was a complete collapse of
the public transport system which acts as one of the
important means for patients to reach the hospital. In this
period, the utilization of private hospital services was
evaluated. The tertiary care teaching hospital in Mysuru,
which is 1800 bedded, attached to medical college
received 42,096 outpatients in March 2020 and 28,221
outpatients in April 2020 against 54,976 outpatients in
March 2019 and 53,271 outpatients in April 2019 in the
same period of the last year and these accounts to almost
60% drop in the footfalls of patients to the hospital, which
directly or indirectly impacted the utilization hospital
and health‑care services.
of many medical appointments, and cancellation or
postponement of elective surgeries until there is clarity
on infection prevalence in the region and means to
control it. In the tertiary care teaching hospital in Mysuru,
a survey of 60 patients who utilized services during the
lockdown and 60 patients who did not utilize despite the
scheduled appointments revealed many factors that help
us to understand the factors contributing to significant
reductions of health‑care utilization in ongoing COVID19
crisis. At the time of writing this article,, the information
obtained from the survey has not been analyzed, but few
important factors have been outlined here to discuss their
impact on private hospitals and health‑care systems.
The Following are The Factors that Affected
the Utilization Rates of Private Health Care
Services
Nationwide lockdown
Since March 24, 2020, India has been under a nationwide
lockdown, now extended by the Central Government
till May 17, 2020, to curb the spread of the coronavirus.
This lockdown has been causing huge disruption,
and distress, to the lives around the world and also
achieved modest reductions in overall hospital
admissions and substantial reductions in the use of daily
OPDs and elective services.
Lack of public transport
As a part of nationwide lockdown, the closure of public
transportation has exacerbated challenges for patients
in accessing health‑care services, especially those
living in rural areas and economically underserved

Although it is easily assumed that lockdown, lack of

public transport, fear of contracting COVID‑19 infection
might have played a role in underutilization of hospital
services, it is important to explore the perspectives
of patients who are the end users of services. The
Government of India has, on March 21, 2020, released
guidelines for the hospitals to prepare for the coronavirus
outbreak. Among other things, hospitals are required
to reserve beds, create isolation wards, and mobilize
additional workforce and train staff, in addition
to arranging for adequate high‑oxygen masks and
ventilators. This resulted in sharp drop in footfalls of
private hospital services such as utilization of outpatient
departments (OPDs), diagnostic testing, prioritizing only
urgent and emergency cases which resulted in canceling Figure 1: Reasons for decline in footfall of patients in private health‑care facilities

S78 International Journal of Health & Allied Sciences - Volume 9, Supplement 1, 2020
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Nilakantam, et al.: Novel Coronavirus – 19 Pandemic Impact On Private Health‑Care Services with Special Focus on Factors Determining Its
Utilization: Indian Scenario
settings, as rural populations are more likely to have
to travel long distances to access health‑care services,
particularly subspecialist services. In urban areas, public
transit is also generally an option for patients to get to
medical appointments. Rural communities often have
more elderly residents who have chronic conditions
requiring multiple visits to outpatient health‑care
facilities. This becomes challenging without availability
of transportation whether it is public or private.
Postponement of elective surgical/diagnostic
procedures
Measures like restrictions on the non-urgent use
of hospitals were imposed, which impacted the
private hospitals performance on surgical services. [5]
These restrictions resulted in shrinkage in the rate of
admissions for elective procedures; however, subject
to the restrictions, majority private hospitals continued
to allow few essential elective admissions. Because,
higher priority should be given to the patients, who are
clinically unstable or if the intervention is predicted to
end in substantial overall survival gain or improvement
of quality of life. Postponement of elective surgeries and
procedures could have an adverse impact on the quality
of life while the patients wait for the right time to get the
treatment they need. Surgeries have been reduced by
approximately 50% nationwide.
Telemedicine
As patients under lockdown and health workers at
the risk of infection, health‑care system is adopting
virtualized treatment approaches that reduced the
physical meeting between patients and health providers.
Digital health technologies are being adopted at a huge
rate now without any technological barriers in the
adoption of virtual health care.[6] As a result of this, most
of the outpatient visits have been shifted from hospitals
toward telehealth visits.
Fear of contact
Patients’ fear of seeking hospital‑based care may have
been an important determinant of hospital services
utilization during the SARS COVID‑19 outbreak.
Although it was concluded at an early stage that the
infection spreads by droplets and it was not immediately
recognized that the virus was so tenacious that it could
survive outside the body on surfaces for long periods.
The estimates of the time that the virus could survive on
various surfaces grew longer and longer – from hours
to days throughout the outbreak – as an understanding
of the virus increased. The fears of SARS COVID‑19
significantly influenced people’s health‑care‑seeking
behavior and that this fear seriously compromised their
access to quality care. It is not just a problem of common
people, even nearly 70% of the medical students were
reluctant to attend clinics from fear of getting infected
International Journal of Health & Allied Sciences - Volume 9, Supplement 1, 2020 S79
or passing on to others during the outbreak[7] because
of initial lack of awareness of the mode of spread of the
virus.
Closure of private clinics
Many of the private medical practitioners across various
cities, especially on the fringes, have stopped opening
their clinics during the lockdown fearing close contact
with coronavirus‑infected patients. With no option left,
many patients despite having minor illness are forced
to rush to crowded hospitals, defeating the purpose of
social distancing.
Homemade medicines/self‑medications
Many patients have started self‑medication, risking
health. Since the commencement of lockdown, there
is a lot of usage and preparation of homemade
medicines by patients. Many families have fallen back
to traditional ayurvedic and herbal medicines that
can be easily prepared at home. This practice of using
homemade medicines has also picked up in villages
and towns as they do not have transportation facilities
to reach the hospitals and clinics. This concept has
gained more importance when the AYUSH ministry
brought measures for enhancing the body’s natural
defense system (immunity) which also included
homemade remedies for illnesses such as dry cough
and sore throat.[8]
Over‑the‑counter medicines
Due to this lockdown because of the COVID‑19
pandemic, people who are suffering from non‑COVID
illness are unable to reach the hospital on time which
resulted in further deterioration of their health condition.
Only those with the knowledge and smartphone could
access virtual treatment, whereas the poorer are still
devoid of these facilities which made them take the
over‑the‑counter medications including many with little
evidence to support their safe use.[9] Thus, both virtual
treatment and over‑the‑counter medicines indirectly
resulted in less utilization of hospital services.
Expected Changes in Post Covid 19 phase
Once the lockdown is lifted, people may rush to
hospitals with new diseases or with the complications
of existing disease. As the lockdown was for a very
long period (already completed 28 days of lockdown
as on April 20, 2020), we can expect the surge in new
cases related to mental health among who suffered
from COVID‑19 and their immediate family due
to nonacceptance of them and among daily wage
workers and migrant laborers due to economic
instability and suicidal tendency among alcoholics,
etc. Another challenge is an epidemiological
shift toward noncommunicable diseases where
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Nilakantam, et al.: Novel Coronavirus – 19 Pandemic Impact On Private Health‑Care Services with Special Focus on Factors Determining Its
Utilization: Indian Scenario
lack of physical activity plays an important role.
Furthermore, elective surgical procedures, checkups,
and other treatments that have been postponed will
likely now be jammed into the second half of this year
in order to comply with insurance plans. Patients of
chronic disease, being wary of going out, or facing
difficulties in movement due to lockdown restrictions
might miss on treatment, ending up with long‑term
sequelae. These can eventually increase the possibility
of complications and worsening of the disease, raising
the overall burden of diseases of the country to a
certain extent. Hence, private health sectors should
also be ready to tackle the other side of the footfall.
It is also expected that patient visits to psychiatry
will be increased not only due to fear of isolation and
stigma attached to those who are being quarantined
and isolated but also because of psychosocial and
socioeconomic impacts. The health‑care community
will begin to prepare for life after COVID‑19, and
the gradual re‑opening of hospitals and practices
of health‑care providers will turn their attention to
addressing their equipment purchases that were
delayed or deprioritized. In addition, new equipment
needs will emerge in order to protect patients such as
testing devices, telemedicine, and safe waiting areas
for patients.
Health care will continue to take center stage as we
continue to battle this pandemic and the anticipated
return of viruses. There will be more robust discussions
of universal health care and basic universal income.
Regardless of the outcome of these debates and the
passage of various new policies, the strengthening of
our health‑care system and the preparation for future
pandemic risks will be widely supported by our
politicians and our citizens. There will be mounting
pressure to ensure each state, and its health‑care
providers to have adequate access to necessary
equipments and supplies, as well as tighter control of
the supply chain by the government.
Conclusion
During COVID‑19 pandemic, health‑care utilization
and medical services decreased significantly which
S80 International Journal of Health & Allied Sciences - Volume 9, Supplement 1, 2020
resulted in significant loss of revenue and increased
use of resources. The immediate shutdown of elective
surgeries, dramatic decreases in patient volumes, and
the measures taken to prepare for a potential surge in
hospitalizations have created immediate and long‑term
financial impacts on the system. The private hospitals
and laboratories, which were already facing multiple
challenges, will witness an acute crisis due to COVID‑19
and the subsequent lockdown, which has resulted in
occupancy levels to fall to a mere 40% by late March
and April vis‑a‑vis pre‑COVID occupancy levels of
65%–70%. This is expected to reduce even further. Hence,
to conclude, SARS COVID‑19 pandemic brought about
not only relatively discernable economic losses but also
observable damage to health‑care organizations, and
this has resulted in a lower health‑care utilization rate.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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