Abstract According to System of Health Accounts (SHA) data total health expenditures in Austria have grown on average by 3.9% per year from 2000 to 2019. This was followed by high growth rates of 5.1% and 11.9% in 2020 and 2021, respectively. The steep increase was caused by the global COVID-19 pandemic. However, quantifying the effect of the pandemic on health expenditures is not straightforward and significant uncertainties remain about how future health expenditures will be affected and how they can most accurately be projected, particularly given recent high economic uncertainties. In this project we developed several models to predict Austrian health expenditures. Most importantly, we compare models based on demand and cost driving factors with a simple GDP-linked model. We assess the performance of the different models by predicting past health expenditure data up to 2019. Comparing the model predictions for the pandemic years with the actual SHA data provides an approach to estimate the net impact of the pandemic. Several different dynamics play a role in how COVID-19 has been affecting health expenditures. We find that the pandemic has caused sizeable one-time costs in the years 2020-2022, but “regular” health expenditures partially decreased during that time due to forgone elective and preventive care. As COVID-19 becomes an endemic disease it also becomes an additional long-term burden on the health system, but the main driver of health expenditure is currently inflation. The shock of the pandemic has created a structural break for the health sector with many not yet well-known consequences such as systematic changes in work conditions or salaries for health sector employees. With the currently available data and information, many of these effects cannot be directly built into the prediction models. However, we compare our models in their projections of future health expenses until 2030 with past projections from 2019 for the year 2030 under different scenarios. Key messages • The pandemic has caused sizeable one-time costs in the years 2020-2022, but “regular” health expenditures partially decreased during that time due to forgone elective and preventive care. • As COVID-19 becomes an endemic disease it also becomes an additional long-term burden on the health system, but the main driver of health expenditure is currently inflation.