Lower Mortality Associated With Preemptive Health System Resource Reallocation During COVID-19: A Longitudinal Study in 85 Countries

OBJECTIVE: Health systems have finite capacity. During crises, policymakers may explicitly reallocate health system resources, or capacity limitations may necessitate implicit resource reallocation. This study modelled timing and intensity of pre-vaccination health system resource reallocation policies to predict excess mortality during the COVID-19 pandemic. METHODS: This longitudinal panel analysis included 85 countries (752 country-months, January 2020-January 2021). The predictor was resource reallocation scope, scale (summarized as intensity, 0-100), and timing. The outcome was all-cause excess mortality (percentage deaths greater than historical average/month). Covariates included COVID-19 incidence and health system parameters. RESULTS: = -0.58, 95%CI -0.93-0.23: e.g., 42,010 fewer deaths per unit increased resource reallocation, March 2020, all study countries). Effects were magnified in older populations. Health system capacity and preparedness were associated with lower mortality. CONCLUSIONS: In the pre-vaccination COVID-19 pandemic, preemptive health system resource reallocation was associated with lower mortality, whereas simultaneous resource reallocation was associated with greater mortality. This longitudinal multinational study indicates that readiness, capacity building, and proactive resource reallocation improve crisis response.