Evaluation of the Case-Mix-Index of Hungarian One-Day Surgical Treatment

OBJECTIVES: One-day surgical care is considered a safe and cost-effective alternative to the cost-demanding inpatient care worldwide. Due to significant technological advances, the range of invasive procedures that can be performed in one-day surgery is steadily increasing in many developed countries. This study aims to analyze the changes in the Case-Mix Index of publicly funded one-day surgical care in Hungary over the period 2010-2022.

METHODS: The study database, which was provided by the National Health Insurance Fund Administration of Hungary, contained all real-world, publicly funded health insurance data relevant to the evaluation. The data sets examined were: one-day surgical number of cases and DRG cost-weights by year, provider, and DRGs as well. The value of CMI annually, institutionally, and according to the medical fields were also contained to the database. During the research descriptive statistics and linear regression were concluded.

RESULTS: The mean value of CMI in Hungarian public-funded one-day surgical care was 0,558 between 2010-2022. The lowest value was captured in 2010 (CMI=0,441), while the highest was in 2022 (CMI=0,598). The COVID pandemic also influenced the annual one-day surgical CMI. The CMI was decreasing during 2019-2021, but its level was not significant (-2%). From an institutional perspective, the university clinics (CMI=0,635) produced the highest CMI, while among town hospitals the lowest value was measured (CMI=0,476). From the viewpoint of medical fields, neurosurgery (CMI=3,160), ambulatory dental care (CMI=1,139), moreover, the invasive cardiology (CMI=1,106) represented the highest level of complexity.

CONCLUSIONS: From 2015 one of the key Hungarian health policy intentions was to increase the dissemination of one-day surgical treatment, thus the financing technique adhered was remarkably beneficial for hospitals in higher level of progressivity system. Based on financial incentives, the university clinics became significantly interested in one-day surgical treatment, which was the prime explaining factor behind the increasing CMI.