This section below summarizes the scientific evidence and jurisdictional information on how other jurisdictions are incorporating COVID-19-related costs in their payment and/or funding models during COVID-19 (i.e., 2020 to Spring 2021) and over the medium term (i.e., Summer 2021 to 2023).

Scientific Evidence

• Types of Hospital Funding during COVID-19: Several studies discussed government funding support provided to hospitals during the pandemic, including paying for the diagnosis and treatment of COVID-19 patients, equipment and supplies (e.g., the building of new facilities), testing, contact tracing, and quarantine. For example, in China all medical expenses were to be prepaid to the designated medical institutions through public insurance funds. Reimbursement to hospitals would follow the established procedures already in place between the insurance funds and hospitals before the start of the COVID-19 pandemic.
• Types of Hospital Funding for the Medium Term: Limited research evidence was identified in the United States (US). One study suggested that targeted financial support for hospitals could take several forms and should change over time to support surge versus ongoing operations as the pandemic evolves: 1) lump-sum payments to help hospitals prepare and respond to the surge in COVID-19 cases; 2) funds disbursed to offset hospitals’ approximate losses due to reduced elective and outpatient revenue, after accounting for their ability to recoup losses in the future when normal operations resume; and 3) state government use of federal funding to further support individual hospitals, based on local assessments of the negative financial consequences of COVID-19. For example, the study found that at least CAD $12 billion of the CAD $210 billion federal emergency fund will target hospitals in areas most affected by COVID-19, and another CAD $12 billion will go to rural health clinics and hospitals.
  • Vaccines and Treatments Lower Health Costs in Long-Term: A modelling study estimated that while treatments and vaccines require major investments in the range of CAD $14.4 billion to CAD $79.2 billion, they have high probabilities of reducing health care costs and increasing quality-adjusted life years, as well as reducing hospital-days and mortality by more than 50%. Consequently, the study recommended that governments focus on expanding health system infrastructure and subsidizing payer coverage to deliver treatments or vaccines efficiently within the next 12 to 24 months.

International Scan

• Health Sector Spending during COVID-19: An OECD report found that across European countries, most fiscal responses amounted to between five to 20% of GDP. COVID‑19‑related budget measures in the health sector included: 1) financing the procurement of specialized medical and personal protective equipment (PPE); 2) expanding testing capacities; 3) hiring of additional workforces; 4) bonus payments; 5) support to hospitals and to subnational governments; and 6) contributions to vaccine development
• Health Sector and Hospital Funding for the Medium Term:Information about health sector and hospital funding for 2021-22 was identified in several jurisdictions: 
  • UK: Emergency spending will continue for 2021-22 with the government fully covering the costs of COVID-19 for public services, which for the health system alone could be around CAD $47 billion. But the government must also attend to the longer term need for investment in people’s health, and wider reform to NHS and social care services.
  • Finland: In 2021, the government committed to reimbursing municipalities and hospital districts for any costs arising from the epidemic, such as expenditures related to testing and the expansion of testing capacity, tracing of transmission chains, quarantines, treatment of patients, health security of those travelling, and a vaccine against the virus.
  • Germany: Since November 2020, Germany has implemented changes in the compensation payments for beds that hospitals reserve for COVID-19 patients. Only hospitals with intensive care capacities that postpone or cancel elective treatments to potentially treat COVID-19 patients are eligible to receive compensation payments. Eligible hospitals can receive compensation payments if they are in areas where less than 25% of free, operable intensive care beds are available and in which the seven-day cumulative incidence is above 70 cases per 100,000 residents.Germany: Since November 2020, Germany has implemented changes in the compensation payments for beds that hospitals reserve for COVID-19 patients. Only hospitals with intensive care capacities that postpone or cancel elective treatments to potentially treat COVID-19 patients are eligible to receive compensation payments. Eligible hospitals can receive compensation payments if they are in areas where less than 25% of free, operable intensive care beds are available and in which the seven-day cumulative incidence is above 70 cases per 100,000 residents.
  • Australia: In 2021, the federal government is ensuring hospital capacity through the COVID-19 pandemic through the National Partnership on COVID-19 Response, which includes a State Health and Hospital 50:50 Sharing Agreement (CAD $2.5 billion) and a private hospital viability guarantee (CAD $1.3 billion). The government is also investing CAD $2.6 billion to ensure the National Medical Stockpile continues to provide access to medicines and PPE to hospitals and to protect the health workforce.
  • US: The main sources of US federal funds for hospitals include: 1) Provider Relief Fund of CAD $213.6 billion that gave virtually all health care providers grants that amounted to at least 2% of their previous annual patient revenue. These grants could be used to cover lost revenue and unreimbursed costs associated with the pandemic; 2) Medicare Accelerated and Advance Payment Programs, which help providers facing cash flow disruptions during an emergency where about 80% of the CAD $120 billion in loans went to hospitals; and 3) Medicare increased all inpatient reimbursement for COVID-19 patients by 20% during the public health emergency, which will likely remain in place throughout 2021.
    • The Center for Medicaid & Medicare Services (CMS) proposed a new rule to update Medicare payment policies and rates for operating and capital‑related costs of acute care for fiscal year 2022 that includes continuing to mitigate potential financial disincentives for hospitals to provide new COVID-19 treatments and to minimize any potential payment disruption immediately following the end of the pandemic. CMS is proposing to extend the COVID-19 Treatments Add-on Payment (NCTAP) for eligible COVID-19 products through the end of the fiscal year in which the pandemic ends.
• Recovery Funding for Backlogs in Elective Care and Continued COVID-19 Care: Several jurisdictions are providing medium term funding to help hospitals manage the backlogs in elective care. For example:
  • Sweden: The government is allocating funding for a recovery bonus in health care and care of older people up to 2023: CAD $40 million (2021); CAD $135 million (2022); and CAD $135 million (2023). It is also providing funding for the non-COVID-19 care backlog and continued COVID-19 care in 2021 (CAD $540 million) and 2022 (CAD $540 million).
  • UK: In 2021-22, hospitals are being allotted CAD $1.7 billion to begin tackling elective care backlogs, addressing the most urgent cases and particularly those who have been waiting for more than 52 weeks for treatment.
• Funding for Long COVID: In the UK, there will be ongoing costs from treatment and support for patients experiencing long-term health impacts from COVID-19, known as long COVID. The cost of this is unknown, though NHS England has pledged CAD $17.42 million for dedicated clinics.

Canadian Scan

• Health Sector Funding for the Medium Term: In the budget years 2021-22, most Canadian provinces are allocating funds to support health systems to recover from the COVID-19 pandemic. For example:
  • British Columbia: In 2021, the government allocated CAD $900 million to support ongoing COVID-19-related health response needs, including vaccine roll-out, testing and screening, and the provision of PPE for frontline health care workers.
  • Alberta: The 2021 budget invests CAD $1.25 billion to address costs for responding to the pandemic, including surgical wait times and backlogs. This is in addition to the CAD $2.1 billion spent in 2020-21.
• Projected Health Sector Spending: It is estimated that additional health care spending in Canada associated with the pandemic will range from CAD $20.1-$26.9 billion in 2020-21 and CAD $15.7-$21.9 billion in 2021-22. By 2030-31, the pandemic will result in an additional CAD $80-$161 billion in health care expenditures and contribute to overall health care spending increasing at an average annual rate of between 5.5-5.7%, depending on the scenario. In addition to providing funds for Canada’s immediate public health response, and supporting provinces and territories in testing, contact tracing, data management, and health system capacity, the Government of Canada’s COVID-19 economic response plan in 2020-21 also includes supports for long-term care residents, COVID-19 medical research and vaccine development, virtual care and mental health tools, and supporting the ongoing public health response in indigenous communities.

Ontario Scan

Funding for Surgery Backlogs and Continued COVID-19 Care: Ontario will invest an additional CAD $1.8 billion in the hospital sector in 2021-22, bringing the total additional investment in hospitals since the start of the pandemic to over CAD $5.1 billion. As part of the province’s CAD $2.8 billion fall preparedness plan, in 2021, the government invested CAD $283.7 million to assist the health system’s ongoing efforts to reduce surgery backlogs, and CAD $457.5 million to ensure that the health system is prepared to respond to any waves or surges of COVID-19 without interrupting routine health services.

The COVID-19 Evidence Synthesis Network is comprised of groups specializing in evidence synthesis and knowledge translation. The group has committed to provide their expertise to provide high-quality, relevant, and timely synthesized research evidence about COVID-19 to inform decision makers as the pandemic continues. The following member of the Network conducted a research and jurisdictional scan that was used to develop this Evidence Synthesis Briefing Note:

• Ontario Health (Cancer Care Ontario). (June 2, 2021). Jurisdictional Scan.
• Ontario Health (Cancer Care Ontario). (June 7, 2021). Research Search.