The commission was responding to proposals to improve post-pandemic hospital funding submitted by neurosurgeon and Huludao consultative conference member Yi Tongjun.

The health authority said it was not in a position to increase funding because the city’s finances were strained as well.

It said the government had spent huge sums dealing with Covid-19 outbreaks in the city, including building treatment facilities and improving coronavirus testing. At the same time, the city’s revenue had taken a major hit.

The city, home to 2.4 million people, reported more than 200 confirmed Covid-19 cases in February and March and introduced strict controls, such as partial lockdowns, online teaching and a ban on dining at restaurants, to stop the outbreaks.

“It was already difficult to maintain normal operations to ensure payment of government debt and to make sure employees of the government and government-affiliated institutions received their salary on time,” the commission said.

It said the high debt level was also related to unsustainable investment by hospitals in infrastructure and equipment.

From January to May, Huludao reported 2.46 billion yuan in public revenue (US$365 million), down 2.8 per cent from the same time last year.

But general expenditure was 8.17 billion yuan, up by more than half over the same period. This outlay included 870 million yuan in spending on health, an increase of 161 per cent.

The problems in Huludao could be the tip of a national public health iceberg.

A National Health Commission report on the performance of public hospitals in 2020 found a general increase in operational costs and financial pressure in the system because of Covid-19 controls.

Among the country’s top-tier hospitals, 43.5 per cent reported losses in 2020, up more than 25 percentage points on the previous year. The number of medical services also fell.

A doctor working at a hospital affiliated with Sun Yat-sen University in Guangzhou said income for medical staff fell by up to half this year compared with 2019 because of the epidemic.

“For example, because of the restrictions on patient admissions, patients from other cities must come to Guangzhou three days in advance to do nucleic acid testing twice. That led to a decrease in the number of patients,” said the doctor, who did not want to be named because she was not authorised to speak to the media.

“During the outbreaks in Guangzhou, we could only do emergency surgery – non-emergency operations were postponed.

“Frequent mass testing also increased spending on labour and equipment, and hospitals had to reserve funds to deal with unexpected situations. That all caused a decrease in revenue, an increase in costs, and a decrease in medical staff income.

“We don’t know when this will end.”

Zhao Wei, a public health professor from Guangzhou-based Southern Medical University, said the struggles of public hospitals reflected economic differences.

Zhao said hospitals that relied on government support would be hit harder because much of the local funding had been spent on disease control.

“But in a megacity like Guangzhou, most public hospitals can be self-sufficient,” he said.