Provider payment mechanisms were adjusted in many countries in response to the COVID-19 pandemic in 2020. Our objective was to review adjustments for hospitals and healthcare professionals across 20 countries. We developed an analytical framework distinguishing between payment adjustments compensating income loss and those covering extra costs related to COVID-19. Information was extracted from the Covid-19 Health System Response Monitor (HSRM) and classified according to the framework. We found that income loss was not a problem in countries where professionals were paid by salary or capitation and hospitals received global budgets. In countries where payment was based on activity, income loss was compensated through budgets and higher fees. New FFS payments were introduced to incentivize remote services. Payments for COVID-19 related costs included new fees for out- and inpatient services but also new PD and DRG tariffs for hospitals. Budgets covered the costs of adjusting wards, creating new (ICU) beds, and hiring staff. We conclude that public payers assumed most of the COVID-19-related financial risk. In view of future pandemics policymakers should work to increase resilience of payment systems by: (1) having systems in place to rapidly adjust payment systems; (2) being aware of the economic incentives created by these adjustments such as cost-containment or increasing the number of patients or services, that can result in unintended consequences such as risk selection or overprovision of care; and (3) periodically evaluating the effects of payment adjustments on access and quality of care.

Belgian Health Care Knowledge Centre Belgium

Center for Social and Economic Strategies Faculty of Social Science Charles University Czechia

Data Sciences for Health Services and Policy Research Institute for Health Sciences in Aragon Spain

Department of Health Care Management Faculty of Economics and Management Technische Universität Berlin Germany

Department of Health Care Management Faculty of Economics and Management Technische Universität Berlin Germany; European Observatory on Health Systems and Policies Belgium

Department of Health Care Management Faculty of Economics and Management Technische Universität Berlin Germany; The Smokler Center for Health Policy Research Myers JDC Brookdale Institute Jerusalem Israel

Department of Health Economics and Social Security Institute of Public Health Faculty of Health Sciences Jagiellonian University Medical College Cracow Poland

European Observatory on Health Systems and Policies Belgium

Faculty of Public Health Health Research Institute Medical Academy Lithuanian University of Health Sciences Lithuania

Faculty of Public Health Medical University Varna Bulgaria

Finnish Institute for Health and Welfare and Tampere University Faculty of Social Sciences Finland

Institute for Research and Information in Health Economics France

London School of Hygiene and Tropical Medicine London UK

National Institute of Public Health of Slovenia Department of Public Health Medical Faculty University of Ljubljana Ljubljana Slovenia

National School of Public Health Management and Professional Development Bucharest Faculty of Medicine University Titu Maiorescu Romania

National School of Public Health Management and Professional Development Bucharest Romania

Netherlands Institute of Health Services Research Utrecht the Netherlands

Section of Hygiene University Department of Life Sciences and Public Health Università Cattolica del Sacro Cuore Italy

Swedish Agency for Health and Care Services Analysis

Tampere University Faculty of Social Sciences Finland

University of Copenhagen Department of Public Health Section for Health Services Research Copenhagen Denmark

University of Lucerne Department of Health Sciences and Medicine Switzerland

UOC ISP Prevention and Surveillance of Infectious and Chronic Diseases Department of Prevention Local Health Authority Jesi Italy

WHO Barcelona Office for Health Systems Financing Spain

Zobrazit více v PubMed

World Health Organization.Regional Office for Europe, “Strengthening the health systems response to COVID-19: policy brief: recommendations for the WHO European Region,” Apr. 2020.

“Data on hospital and ICU admission rates and current occupancy for COVID-19,” European Centre for Disease Prevention and Control, Apr. 15, 2021. https://www.ecdc.europa.eu/en/publications-data/download-data-hospital-and-icu-admission-rates-and-current-occupancy-covid-19 (accessed Apr. 19, 2021).

Technishce Universitat Berlin, Department of Health Care Management, “COVID-19: database on patients treated as inpatients and in hospitals in 31 European countries - updated monthly,” Faculty VII Economics & Management: current information. https://www.tu-berlin.de/?49992 (accessed Apr. 19, 2021).

“COVID-19 health system response monitor.” https://www.covid19healthsystem.org/mainpage.aspx (accessed May 04, 2021).

Webb E., Hernández-Quevedo C., Williams G., Scarpetti G., Reed S., Panteli D. Providing health services effectively during the first wave of COVID-19: a cross-country comparison on planning services, managing cases, and maintaining essential services. Health Policy. 2021 doi: 10.1016/j.healthpol.2021.04.016. May. PubMed DOI PMC

Gandjour A. How many intensive care beds are justifiable for hospital pandemic preparedness? A cost-effectiveness analysis for COVID-19 in Germany. Appl Health Econ Health Policy. 2021;19(Mar. (2)):181–190. doi: 10.1007/s40258-020-00632-2. PubMed DOI PMC

Quentin W., et al. Adjusting hospital inpatient payment systems for COVID-19 health system assessment view project EuroDRG view project 88 paying for services adjusting hospital inpatient payment systems for COVID-19. EuroHealth‏. 2020;26(2):88–92.

Waitzberg R., et al. Compensating healthcare professionals for income losses and extra expenses during COVID-19. Eurohealth. 2020;26(2):83–87.

Robinson J.C. Theory and practice in the design of physician payment incentives. Milbank Q. 2001;79(Jun. (2)):149–177. doi: 10.1111/1468-0009.00202. PubMed DOI PMC

Ellis Randal, Miller Michelle McKinnon. In: Health Systems Policy, Finance, and Organization, 1st ed., vol. 3. Guy Carrin Kent Buse, Heggenhougen Kristian, Quah Stella R., editors. Academic Press; Amsterdam: 2009. Provider payment and incentives.

Cots F., Chiarello P., Salvador X., Castells X., Quentin W. In: Diagnosis-related groups in Europe: moving towards transparency, efficiency and quality in hospitals. Busse R., Geissler A., Quentin W., Wiley M., editors. Open University Press and WHO Regional Office for Europe; Buckingham: 2011. DRG-based hospital payment: intended and unintended consequences; pp. 75–92.

Rechel B., Maresso A., Van Ginneken E. European Observatory on Health Systems and Policies; Copenhagen: 2010. Health systems in transition - template for authors.

S. Thomson, T. Habicht, and T. Evetovits, “How are countries mobilizing additional public funds for health?,” Apr. 2020. Accessed: Aug. 19, 2021. [Online]. Available: https://eurohealthobservatory.who.int/monitors/hsrm/analyses/hsrm/how-are-countries-mobilizing-additional-public-funds-for-health.

R.P. Ellis and T.G. Mcguire, “Hospital response to prospective payment: moral hazard, selection, and practice-style effects,” 1996. PubMed

Newhouse J.P. Reimbursing health plans and health providers: efficiency in production versus selection. J Econ Lit. 1996;34(3):1236–1263.

Jegers M., Kesteloot K., De Graeve D., Gilles W. A typology for provider payment systems in health care. Health Policy. 2002;60(Jun. (3)):255–273. doi: 10.1016/S0168-8510(01)00216-0. PubMed DOI

OECD . OECD Publishing; Paris: 2016. Better Ways to Pay for Health Care, OECD Health Policy Studies. DOI

Ellis R.P., Martins B., Miller M.M. In: International encyclopedia of public health. Heggenhougen S.R., Quah H.K., editors. 2015. Provider payment methods and incentives.

Quinn K. The 8 basic payment methods in health care. Ann Intern Med. 2015;163(Aug. (4)):300. doi: 10.7326/M14-2784. PubMed DOI

Ellis R.P., McGuire T.G. Supply-side and demand-side cost sharing in health care. J Econ Perspect. 1993;7(4):135–151. doi: 10.1257/jep.7.4.135. PubMed DOI

Ellis R.P. Creaming, skimping and dumping: provider competition on the intensive and extensive margins. J Health Econ. 1998;17(Oct. (5)):537–555. doi: 10.1016/S0167-6296(97)00042-8. PubMed DOI

Van Barneveld E.M., Lamers L.M., Van Vliet R.C.J.A., Van De Ven W.P.M.M. Risk sharing as a supplement to imperfect capitation: a tradeoff between selection and efficiency. J Health Econ. 2001;20(Mar. (2)):147–168. doi: 10.1016/S0167-6296(00)00077-1. PubMed DOI

Waitzberg R., Quentin W., Webb E., Glied S. The structure and financing of health care systems affected how providers coped with COVID-19. Milbank Q. 2021;99(Jun. (2)):542–564. doi: 10.1111/1468-0009.12530. PubMed DOI PMC

Quentin W., et al. Paying hospital specialists: experiences and lessons from eight high-income countries. Health Policy. 2018;122(May (5)):473–484. doi: 10.1016/j.healthpol.2018.03.005. PubMed DOI

Health care provider payment schemes and their changes since 2010 across nine Central and Eastern European countries - a comparative analysis