Health Systems in Transition - Hungary - World Health Organization ...

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Health systems in transition Hungary
Fig. 7.5
NHIFA payment per HDG cost weight (point) as a percentage of the 1994 figure
(1994 = 100%), 1994–2008
1989
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Source: Information Centre for Health Care, 2010.
NHIFA payment per
HDG cost weight (point)
as % of the 1994
It is important to note that this increase in output would have been even
more substantial if the cost weights of all HDGs had not been regularly cut
back to offset the steady increase in the average case severity, the so-called
case-mix index (CMI) (Fig. 7.6). This process is called “re-standardization” and
assumes that part of the increase in the total number of points produced in a
particular year is the result of an upcoding of cases in the provider’s report to
the NHIFA and not of a real increase in case severity. It is well known that the
HDG system incentivizes hospitals to assign actual cases the highest possible
severity in order to create more revenue (DRG-creep), thus increasing the CMI
(Hsia et al., 1992; Rosenberg & Browne, 2001). There is some evidence of
DRG-creep in the Hungarian health care system, as the increases in the CMI
have not been accompanied by an increase in hospital mortality (Table 7.4).
Any interpretation of efficiency indicators must take into account that a rise in
output may represent manipulated reporting rather than a real increase on the
one hand or better coding practices on the other.