Analysis of the Balanced Scorecard's Financial Subdimensions in Health Care Organizations During the COVID-19 Pandemic

OBJECTIVES: This research intended to perform a systematic review to identify all the financial subdimensions used in balanced scorecard (BSC) implementations and then to assess the impact of the pandemic on the financial subdimensions of health care organizations (HCOs).

METHODS: This research consists of two steps. First, we performed a systematic review in accordance with PRISMA guidelines to find all financial key performance indicators (KPIs) used in BSC implementations from the time of inception until October 2020 in PubMed, Embase, Cochrane, Google Scholar databases, and Google's search engine. Second, we performed a further analysis by searching for independent studies using the resulting financial subdimensions at the review with the COVID-19 keyword in Google engine and Google Scholar until June 2021.

RESULTS: Out of 4031 studies, 36 implementations remained. From these, 101 financial KPIs were extracted. Regrouping of these KPIs resulted in 4 financial subdimensions: margins, expenditures and costs, revenues, and revenues vs expenditures ratios. In the next step, studies at the beginning of the pandemic suggested that hospitals will experience sharp reductions in elective and outpatient payments, which will create unprecedented financial challenges for HCOs. In addition to the higher costs of health care workers (HCWs) and resources, researchers found higher costs of treatment due to extra diagnostic tests and isolation costs. In the United Kingdom, the total expenditure on the National Health System (NHS) has increased significantly during the pandemic due to expanding waiting areas and treatment cubicles. Some studies have focused on cost-effectiveness calculations; for example, purchasing intensive care unit (ICU) capacity from the private sector during COVID-19 may not be a cost-effective investment.

CONCLUSIONS: A lack of studies that handle the financial subdimensions or develop cost-saving strategies at the health organization level in COVID-19 was perceived. Future research in this aspect is needed.