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

1.3
1.2
1.1
1.0
0.9
Health systems in transition Hungary 205
Fig. 7.6
CMI in Hungary, 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.
CMI (case mix-index)
Making a robust statement about the technical (production) efficiency of
the Hungarian acute inpatient care sector requires that several other points be
taken into account. First, HIF payments are not the only source of expenditure
associated with acute inpatient care. There are also capital costs, which are
covered separately by the owners of health care facilities. In addition, patients
often pay physicians (and, to a lesser extent, other health care workers)
informally. Another portion of financing is covered by suppliers providing
extra-long payment deadlines, and there are also some minor external sources of
funding, such as donations by charities. The share of these additional financing
sources is, however, much smaller than that of the HIF, and they have followed
trends over time that are, by and large, in line with those followed by HIF
expenditure on acute inpatient care.
Second, an increase in output and a reduction of cost produces efficiency
gains only if the quality of care does not suffer in the process. Trends for certain
indicators of hospital mortality, avoidable causes of death (Fig. 7.7) or infant
and maternal mortality have not been unfavourable and, in some cases, have
improved (Table 1.10). At the very least, this suggests that the quality of acute
inpatient care has not been affected dramatically. It is worth noting that there
are some built-in mechanisms in the HDG system to prevent providers from
cutting costs at the expense of the quality of care, such as the lower threshold
of length of stay for each HDG.