Evidence Based Health Policy, Management & Economics

en The Impact of COVID-19 on Entrepreneurship and Economic Outcomes in Emerging Markets: A Difference-in-Differences Approach Health Economics پژوهشي Original article Background: The COVID-19 pandemic profoundly disrupted global economic systems, with emerging markets facing unique challenges due to structural vulnerabilities and limited institutional resilience. While existing literature has explored macroeconomic shocks, the specific effects on entrepreneurship and the role of policy interventions in mitigating these impacts remain underexamined. This study addresses this gap by analyzing how the pandemic affected entrepreneurial activity and broader economic outcomes in emerging markets, with a focus on the efficacy of government responses and adaptive strategies. Methods: A quasi-experimental Difference-in-Differences (DID) approach was employed to compare pre- and post-pandemic entrepreneurship indicators and macroeconomic data across 15 emerging markets. Data were sourced from the World Bank Enterprise Surveys, International Labour Organization (ILO), and national statistical agencies (2018–2022). Variables included business closure rates, Small and Medium-sized Enterprises (SME), investment levels, unemployment trends, fiscal stimulus allocations, and digital technology adoption. Robustness checks accounted for cross-country heterogeneity in income levels, industrial composition, and institutional quality. Results: The pandemic triggered a 27% average increase in business closures and a 15% decline in SME investment across sampled countries. Unemployment rates rose by 9.3%, disproportionately affecting informal sectors. Government interventions, particularly fiscal stimulus packages exceeding 5% of gross domestic product (GDP) and targeted SME tax relief, reduced closure rates by 12% and preserved 8% of jobs. Digital transformation including e-commerce adoption, mitigated revenue losses by 18% in sectors with high pre-pandemic digital readiness. Cross-country analysis revealed that lower-middle-income economies experienced 35% greater entrepreneurial disruption than upper-middle-income counterparts, highlighting the role of institutional resilience and industrial diversification. Conclusion: The COVID-19 crisis underscored the fragility of entrepreneurial ecosystems in emerging markets, and also demonstrated the critical role of adaptive policies and digital infrastructure. Sustainable recovery requires integrated strategies combining fiscal support, institutional capacity-building, and technology-driven entrepreneurship. This study contributes to policy discourse by quantifying the efficacy of interventions and providing a framework for enhancing economic resilience in future crises.   COVID-19, Entrepreneurship, Emerging Markets, Difference-in-Differences, Economic Resilience 285 301 http://jebhpme.ssu.ac.ir/browse.php?a_code=A-10-524-1&slc_lang=en&sid=1 Matin Ghaemi Rad matin.rad77@gmail.com 1- 0000-0003-4287-5234 No Department of Administrative and Economic Sciences, Faculty of Humanities, Gonbad Kavous University, Gonbad Kavous, Iran Mohsen Mohammadi Khyareh m.mohamadi@ut.ac.ir 0000-0003-3977-0929 Yes Department of Administrative and Economic Sciences, Faculty of Humanities, Gonbad Kavous University, Gonbad Kavous, Iran Vahid Osku vahidoskou@gmail.com 0000-0002-8028-5856 No Department of Administrative and Economic Sciences, Faculty of Humanities, Gonbad Kavous University, Gonbad Kavous, Iran