Health policy and COVID-19: path dependency and trajectory

The coronavirus disease (COVID-19) pandemic has tested the mettle of governments across the globe and has thrown entrenched fault lines within health systems into sharper relief. In response to the outbreak of the pandemic, governments introduced a range of measures to meet the growth in demand and bridge gaps in health systems. The objective of this paper is to understand the nature and extent of the changes in health systems triggered by the COVID-19 crisis. The paper examines changes in the role of governments in (1) sector coordination, (2) service provision, (3) financing, (4) payment, and (5) regulations. It outlines broad trends and reforms underway prior to the pandemic and highlights likely trajectories in these aspects in the future. The paper argues that while the pandemic has accelerated changes already underway before the crisis, it has made little headway in clearing the path for other or deeper health policy reforms. The reform window that COVID-19 opened has not been wide enough to overcome the entrenched path dependency and structural interests that characterize the sector.