Hospital Financial Strategy in Response to COVID-19: A Systematic Review


  • Suci Kirana Yulius Hospital Administration Studies Program, Faculty of Public Health, Universitas Indonesia
  • Prastuti Soewondo Faculty of Public Health, Universitas Indonesia
  • Brenda Carolinsia Hospital Administration Studies Program, Faculty of Public Health, Universitas Indonesia


Background: The COVID-19 pandemic had resulted in an unprecedented strain on healthcare syste­ms. Hospitals are faced with the unexpected influx of patients, increasing need for protection equ­ip­ment and infection control procedures, increased workload and operational hours, and the depleting revenues due to closure of elective services. This study aims to further analyze the financial str­a­tegies used by hospitals to ensure its operations and to overcome financial challenges presented by the COVID-19 pandemic.

Subjects and Method: A systematic review has been identified using four databases: MEDLINE (Pub­Med), Google Scholar, SCOPUS, and MedSci. This search in literature was published articles from January 2020 to June 2021 using PRISMA guidelines. The keywords used “COVID-19” OR “SAR­S-CoV-2” AND (ii) "hospital" OR "hospital cost" OR "cost" AND (iii) "strategy" OR "financial stra­tegy" OR "economic" OR "economic analysis".

Results: 6 studies were included in our final analysis. We found that effective financial strategies to co­ver for reduced revenues and increasing cost of care include: (1) Ensuring incentives from external ag­e­ncies, including the government; (2) Creating new budgets or modifying existing budgets to cover for COVID-19-related cost of care; and (3) Use of contactless health system such as telehealth. Speci­fically for modifying existing budgets, studies have found that implementing proper health protocol and infection control measures is the most effective, as it has been reported to yield a return of invest­ments.

Conclusion: Government funds and relief aids remain the most important source of financial suppo­rt for hospitals in caring for COVID-19 patients. Without sufficient financial support, hospitals have to get creative in adding additional service fees or finding innovative solutions such as telehealth to cover the dwindling revenues from their closed service units.

Keywords: COVID-19, hospital cost, financial strategies

Correspondence: Suci Kirana Yulius. Hospital Administration Studies Program, Faculty of Public Health, Universitas Indonesia. Universitas Indonesia Pondok Cina, Beji, Depok City, West Java. Mobile: 081273874947­­.­ E­mail:

Journal of Health Policy and Management (2002), 07(01): 81-93


Ahuja G, Verma M, Patkar D (2021). Financial impact of COVID19 on radiology practice in India. Indian J Radiol Imaging. 31(5): S31–S37. doi: 10.4103/ijri.IJRI_305_20

Atmojo JT, Sudaryanto WT, Widiyanto A, Ernawati E, Arradini D (2020). Telemedicine, Cost Effectiveness, and Patients Satisfaction: A Systematic Review. Int. J. Health Policy Manag. 5(2): 103–107. doi: 10.26911/thejhpm.2020.05.02.02

Bappenas KP. (2021). Studi Pembelajaran Penanganan COVID19 Indonesia. Edisi 1. Jakarta: Bappenas

Boserup, McKenney E (2020). Since January 2020 Elsevier has created a COVID19 resource centre with free information in English and Mandarin on the novel coronavirus COVID 19 . The COVID19 resource centre is hosted on Elsevier Connect , the company’ s public news and information. Am J Emerg Med. 45 (June): 530–531. doi: 10.1016/j.ajem.2020.07.007.

Chen CL, Lai CC, Luh DL, Chuang SY, Yang KC, Yeh YP, Yen AMF, et al. (2021). Review of epidemic, containment strategies, clinical management, and economic evaluation of COVID19 pandemic. JFMA. 120: S6–S18. doi: 10.1016/j.jfma.2021.05.022

Cohen J, Rodgers YM (2020). Contributing factors to personal protective equipment shortages during the COVID19 pandemic. Preventive Medicine. 141. doi: 10.1016/j.ypmed.2020.106263

Her M (2020). Repurposing and reshaping of hospitals during the COVID19 outbreak in South Korea. One Health. 10. doi: 10.1016/j.onehlt.2020.100137

Jatnika VV, Soewondo P, Muliawati M (2021). Strategy In Anticipating The Hospital’s Financial Condition During The Covid19 Pandemic: A Systematic Review. Jurnal Ilmiah Akuntansi Dan Keuangan, 4(September).

Klein MG, Cheng CJ, Lii E, Mao K, Mesbahi H, Zhu T, Muckstadt JA, et al (2020). COVID19 Models for Hospital Surge Capacity Planning: A Systematic Review. Disaster Medicine and Public Health Preparedness. doi: 10.1017/dmp.2020.332

Kruse CS, Krowski N, Rodriguez B, Tran L, Vela J, Brooks M (2017). Telehealth and patient satisfaction: A systematic review and narrative analysis. BMJ Open. 7(8): 1–12. doi: 10.1136/bmjopen2017016242

Mahmood SU, Crimbly F, Khan S, Choudry E, Mehwish S (2020). Strategies for rational use of personal protective equipment (PPE) among healthcare providers during the COVID19 crisis. Cureus. 12(5): e8248. doi: 10.7759/cureus.8248

McCabe R, Schmit N, Christen P, D’Aeth JC, Løchen A, Rizmie D, Nayagam S, et al. (2020). Adapting hospital capacity to meet changing demands during the COVID19 pandemic. BMC Medicine, 18(1). doi: 10.1186/s1291602001781w.

Monaghesh E, Hajizadeh A (2020). The role of telehealth during COVID19 outbreak: A systematic review based on current evidence. 4: 1–9. doi: 10.21203/rs.3.rs23906/v1

Naamati SL (2020). Strategic management as adaptation to changes in the ecosystems of public hospitals in Israel. Isr. J. Health Policy Res. 9(1): 1–11. doi: 10.1186/s1358402000424y

Nguyen L, Drew D, Joshi A, Guo CG, Ma W, Mehta R, Sikavi, et al (2020). Risk of COVID19 among frontline healthcare workers and the general community: a prospective cohort study. Lancet Public Health. 5: e47583. doi: 10.1101/2020.04.29.20084111

Park S, Maher CS (2020). Government Financial Management and the Coronavirus Pandemic: A Comparative Look at South Korea and the United States. Am. Rev. Public Adm. 50(6–7): 590–597. doi: 10.1177/0275074020941720

Prinja S, Pandav CS (2020). Economics of COVID19: challenges and the way forward for health policy during and after the pandemic. Indian J. Public Health. 64: S231–S233. doi: 10.4103/ijph.IJPH_524_20

Provenzano DA, Sitzman BT, Florentino SA, Buterbaugh GA (2020). Clinical and economic strategies in outpatient medical care during the COVID19 pandemic. Regional Anesthesia and Pain Medicine. 45(8): 579–585. doi: 10.1136/rapm2020101640

Quentin W, Albreht T, Bezzina A, Bryndova L, Dimova A, Gerkens S, KowalskaBobko I, et al. (2020). Adjusting hospital inpatient payment systems for COVID19. Eurohealth. 26(2): 88–92.

Risko N, Werner K, Offorjebe A, VecinoOrtiz A, Wallis L, Razzak J (2020). CostEffectiveness and Return on Investment of Protecting Health Workers in Low and MiddleIncome Countries during the COVID19 Pandemic. SSRN Electronic Journal. doi: 10.2139/ssrn.3581455

Shin JH, Takada D, Morishita T, Lin H, Bun S, Teraoka E, Okuno T, et al. (2020). Economic impact of the first wave of the COVID19 pandemic on acute care hospitals in Japan. PLoS ONE. 15(12 December). doi: 10.1371/journal.pone.0244852

Shoja E, Aghamohammadi V, Bazyar H., Moghaddam HR., Nasiri K., Dashti M, Choupani A, et al. (2020). Covid19 effects on the workload of Iranian healthcare workers. BMC Public Health. 20(1). doi: 10.1186/s1288902009743w

Smith AC, Thomas E, Snoswell CL, Haydon H, Mehrotra A, Clemensen J, Caffery LJ (2020). Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID19). J Telemed Telecare. 26(5): 309–313. doi: 10.1177/1357633X20916567

Squire MM, Munsamy M, Lin G, Telukdarie A, Igusa T (2021). Modeling hospital energy and economic costs for COVID19 infection control interventions. Energy and Buildings: 242. doi: 10.1016/j.enbuild.2021.110948

Sundararaman T (2020). Health systems preparedness for COVID19 pandemic. Indian J. Public Health. 64: S91–S93. doi: 10.4103/ijph.IJPH_507_20

The World Health Organization. (2021). WHO Coronavirus (COVID19) Dashboard.

Turner S, Niño N (2020). Qualitative analysis of the coordination of major system change within the Colombian health system in response to COVID19: study protocol. Implementation Science Communications. 1(1): 1–8. doi: 10.1186/s4305802000063z

Wan KS, Tok PSK, Ratnam KKY, Aziz N, Isahak M, Zaki, RA, Farid NDN, et al (2021). Implementation of a COVID19 surveillance programme for healthcare workers in a teaching hospital in an uppermiddleincome country. PLoS ONE. 16(4 April). doi: 10.1371/journal.pone.0249394




How to Cite

Yulius, S. K., Soewondo, P., & Carolinsia, B. (2022). Hospital Financial Strategy in Response to COVID-19: A Systematic Review. Journal of Health Policy and Management, 7(1), 81–93. Retrieved from