The Covid-19 crisis has cost NHS Tayside more than £5.8 million since the end of March.
Health bosses are warning waiting times, new medicines and service improvements could be put at risk if the Scottish Government does not step forward and meet the bill.
They warn the extra costs may prevent the beleaguered board from breaking even this financial year – the first time it was expected to do so for seven years.
Chiefs are now carrying out a full review of the board’s financial plan.
Costs are expected to rise yet further as the board prepares to share its remobilisation plans for services with the Scottish Government this week.
The board is also warning of an extra £2 million cost as it takes over operational responsibility for Inpatient Mental Health Services as part of moves to improve under-performing services in this area.
Chief executive Grant Archibald told board colleagues on Thursday “Covid-19 has changed the landscape” regarding spending.
He said prior to the crisis colleagues had delivered a “double helix” – outperforming saving targets for the previous two years while improving services.
NHS Tayside has struggled in previous years to reduce a large deficit, relying on “financial flexibility” from the Scottish Government to maintain services.
Senior finance manager Karen Kidd warned, in a report to health board colleagues, the additional Covid-19 costs could hurt service provision in the area.
She said in her report: “Funding allocations assumed for other purposes within the board’s financial plan may be at risk.
“These include significant allocations for waiting times, new medicines, and a range of service issues.”
Director of finance Stuart Lyall said the board was “now living within the rules of the game” in the way it had managed its finances immediately prior to the pandemic.
He said: “Covid-19 introduces something different. We will rise to that challenge.”
The board reported an overspend of £6.6 million to the end of June for the three months of this financial year, which includes Covid-19 costs of £5.8 million.
He said there was no additional Scottish Government funding assumed for Covid-19 costs in 2020/21 “at this stage”, but was hopeful the Scottish Government would ultimately meet the shortfall.
The health board had spent an extra £2.5 million tackling Covid-19 in the previous financial year, costs which were met by St Andrews House, he added.
The £5.8m total includes £1.6m for additional beds, including those in intensive care, £2.4m on staffing costs and half a million on locally-sourced PPE.
The board spent around £300,000 on community hubs during the pandemic.
The Scottish Government spokeswoman said:
“The Scottish Government is working closely with NHS Tayside, along with all NHS Boards, to scrutinise and confirm all financial implications of responding to Covid-19.
“We are carrying out a detailed review of actual expenditure during the first quarter of 2020 and, following that, we will then make a funding allocation to Boards to recognise costs incurred.
“The Board’s financial report sets out additional Covid costs, while making clear that the figures presented do not yet factor in additional funding from the Scottish Government.
“The Scottish Government will provide the necessary funding across the sector in recognition of costs incurred to date, and to support remobilisation of services, while ensuring that patient safety remains the top priority at all times.”