Impact of the COVID-19 pandemic on healthcare utilisation and hospital finances in selected private sector hospitals in India: an interrupted time-series study

Hospitals are more than just places where the sick are treated; they are complex engines that must keep running even when the world outside stops. For a healthcare system to survive a crisis, it needs two things working in tandem: the ability to keep seeing patients for their everyday needs, and the financial strength to pay for the staff, medicine, and equipment required to do so. When a sudden, massive health emergency strikes, these two needs often clash. Resources are diverted to the immediate crisis, and people who are afraid of infection or unable to travel may stop coming for routine care. This creates a dangerous gap where the system is overwhelmed by the new emergency while simultaneously losing the revenue and patient flow that keeps it afloat. Understanding how this balance shifts is critical, because if a hospital runs out of money or staff during a crisis, it cannot help anyone, regardless of the severity of the illness.

In India, where nearly sixty percent of people seek medical care in private facilities rather than government ones, the resilience of these private hospitals is a matter of national importance. A team of researchers set out to measure exactly how the COVID-19 pandemic disrupted this delicate balance. They gathered detailed monthly records from fourteen private hospitals across the country, tracking everything from the number of people walking through the front door to the money coming in and going out. They looked at three distinct eras: the time before the virus arrived, the first year of the pandemic which included strict lockdowns and the first wave of infections, and the second, more severe wave of infections that hit in early 2021. By comparing what actually happened against what would have been expected if the pandemic had never occurred, the researchers could see the true cost of the crisis on both patient care and hospital budgets.

The story the data tells begins with a sudden, sharp drop. When the government imposed a nationwide lockdown in April 2020 to stop the spread of the virus, the flow of patients into these hospitals nearly halted. In that single month, the number of people visiting outpatient clinics fell by nearly half compared to normal trends. At the same time, the number of people admitted to stay in the hospital dropped by forty percent, and the number of surgeries performed fell by almost half. This was not just a pause; it was a massive disruption. The financial impact was immediate and severe. Total income for these hospitals fell by thirty-eight percent in that same month. While costs went down by twenty-eight percent because fewer services were being provided, the loss of revenue was far greater, creating a financial hole that would take time to fill.

As the months passed through the first year of the pandemic, a slow, partial recovery began to take shape. The hospitals did not return to normal immediately, but the numbers started to climb back up. Outpatient visits and surgeries began to increase by about three to four percent each month, suggesting that people were slowly returning for care once the initial fear and restrictions eased. However, the pattern changed drastically when the second wave of the virus arrived in March 2021. This time, the story was different. Instead of a drop in activity, there was a surge in demand for acute and critical care. Emergency room visits jumped by twenty-four percent, and admissions to intensive care units nearly doubled, rising by ninety-eight percent. The hospitals were once again overwhelmed, but this time by a flood of critically ill patients rather than an empty waiting room.

The researchers also discovered that the pandemic did not affect all hospitals in the same way. The impact depended heavily on whether a hospital was treating COVID-19 patients or not. Hospitals that took in COVID-19 patients saw a rise in their overall income and a massive increase in the number of people they treated, but they also faced much higher costs and had to provide more financial concessions to patients who could not pay. In contrast, hospitals that did not treat COVID-19 patients suffered a much deeper decline in their routine services. These facilities saw fewer people coming for everything from eye care to kidney treatment, and their financial health deteriorated more severely because they lost their regular patient base without gaining the surge of emergency cases that the other hospitals experienced.

The financial strain was felt in the details of how these hospitals operated. To survive, many institutions had to make difficult choices. Some temporarily reduced staff salaries or asked employees to defer their pay. Others began making their own protective gear and hand sanitizer to save money, while others had to spend heavily to restructure wards and buy new equipment to handle the sick. The data showed that while some costs went down because fewer people were coming in, the cost of preparing for the virus and treating the critically ill often pushed expenses back up. In the second wave, the demand for oxygen and intensive care beds became so high that some hospitals had to restrict admissions simply because they did not have enough resources to keep everyone safe.

Ultimately, the study reveals that the pandemic created a two-phase crisis for private healthcare in India. The first phase was defined by silence and emptiness, where the fear of infection and lockdown rules kept patients away, causing a sharp drop in both care and income. The second phase was defined by a chaotic surge, where the system was flooded with critically ill patients, driving up demand for emergency services but also straining resources to the breaking point. The hospitals that managed to stay open were those that could adapt quickly, shifting their focus and managing their finances through a period of extreme uncertainty. The findings suggest that for future health emergencies, hospitals need to be prepared not just for a sudden influx of patients, but also for the long, quiet periods where routine care stops and revenue dries up, ensuring they can survive the silence before the storm returns.