Medical Resource Scarcity and Inequality in COVID-19 Fatality Rates: Evidence From Hospitalized Patients in Wuhan, China.

Wuhan, China, where SARS-CoV-2 was detected first, has been recorded as one of the epicenters with the highest COVID-19 fatality rates worldwide. High COVID-19 fatality rates may stem from severe medical resource scarcity, especially in the early stage of the pandemic outbreak. In the first few weeks of the COVID-19 outbreak, Wuhan experienced the hardship of a severe "hospital run" period, when hospitals operated far beyond their maximum capacity and then soon transformed into "inclusive healthcare," that is, every infectious person can access free medical treatment. Based on detailed administrative data of hospital admission and medical treatment for 1537 COVID-19 patients, we investigate how the COVID-19 fatality rates can be affected by the patient's socioeconomic status (SES) and differences in the effect between the two periods. Our estimation results show that low-SES patients had higher fatality rates during the "hospital run" period. Differential opportunities for hospitalization do not drive this inequality in fatality rates; rather, they are driven by the medical treatment after hospital admission, namely reduced treatment intensity and limited access to specific medical treatment and medications for COVID-19. When the government implemented the "inclusive healthcare" policy, severe medical resource scarcity was alleviated, and the inequality in fatality rates ceased to exist. These findings verify the existence of medical inequality among low-SES people amid severe medical resource shortages and also highlight the importance of rapidly increasing hospital capacity and medical supply in reducing possible unequal treatment and tackling inequalities in medical outcomes, especially during a public health crisis.