ROBOTIC SURGERY IN HUNGARY (2022-2025): EXPANSION, CASE-MIX DYNAMICS, AND PROVIDER CONCENTRATION
Author(s)
Róbert Pónusz, MSc, PhD1, Dalma Pónusz-Kovács, MSc2, Csaba Könczei, MSc2, Kristóf Mangel, MSc3, Attila Vas Tifán, MD, MSc2, Bettina Kovács, BSc, MSc2, Imre Boncz, MSc, PhD, MD1;
1University of Pécs, Faculty of Health Sciences, Institute for Health Insurance, Pécs, Hungary, 2University of Pécs, Doctoral School of Health Sciences, Pécs, Hungary, 3National Directorate General for Hospitals, Legal department, Budapest, Hungary
1University of Pécs, Faculty of Health Sciences, Institute for Health Insurance, Pécs, Hungary, 2University of Pécs, Doctoral School of Health Sciences, Pécs, Hungary, 3National Directorate General for Hospitals, Legal department, Budapest, Hungary
OBJECTIVES: Robotic surgeries have ever increased market share in many advanced healthcare systems. In Hungary the robotic-assisted surgeries are covered in a centralized way, by half dozens of hospitals. The aim of the study is to describe the inpatient robotic surgery activity in Hungary and quantify inter-hospital concentration and case-mix changes between 2022 and 2025.
METHODS: The study database was derived from The National Directorate General for Hospitals. The robotic-surgery-related DRG activity for 2022-2025 (October) was evaluated. Outcomes were annual unique patients, cases, and DRG cost-weights; hospital market shares, medical specialties and ICD-10 distributions. We computed concentration (Herfindahl-Hirschman Index [HHI], 3-firm concentration ratio [CR3], Gini) and tested temporal changes in specialty mix (chi-square) and mean cost-weight per case across years (ANOVA).
RESULTS: Cases increased from 591 (557 patients; 5,590 DRG cost-weights) in 2022 to 2,663 (2,458 patients; 23,200 DRG cost-weights) in 2025; representing 4.51-fold more cases and 4.15-fold more cost-weights versus 2022. Activity was concentrated in six centers; the National Institute of Oncology accounted for 35.99% of cases and the top three providers for 77.63% (HHI=0.241; Gini=0.374). General surgery (27.49%), urology (23.74%), and gynaecology (21.46%) comprised 72.68% of activity. The specialty distribution shifted over time (chi-square: p<0.001). Mean cost-weight per case declined from 9.44 in 2022 to 8.68 in 2025 (p=0.0066).
CONCLUSIONS: Robotic surgery inpatient activity expanded rapidly with moderate-to-high provider concentration and a small but statistically significant shift in specialty mix. To the declining cost-weight per case reflects changing case complexity and the refinement of financing techinique, because since 2022 there was only 1 piece of robotic-surgery related DRG, with the increased involvement of fellow OR-related specialities from May 2025, 9 pieces of specified DRGs were applied more tailored for the mix and need of cost.
METHODS: The study database was derived from The National Directorate General for Hospitals. The robotic-surgery-related DRG activity for 2022-2025 (October) was evaluated. Outcomes were annual unique patients, cases, and DRG cost-weights; hospital market shares, medical specialties and ICD-10 distributions. We computed concentration (Herfindahl-Hirschman Index [HHI], 3-firm concentration ratio [CR3], Gini) and tested temporal changes in specialty mix (chi-square) and mean cost-weight per case across years (ANOVA).
RESULTS: Cases increased from 591 (557 patients; 5,590 DRG cost-weights) in 2022 to 2,663 (2,458 patients; 23,200 DRG cost-weights) in 2025; representing 4.51-fold more cases and 4.15-fold more cost-weights versus 2022. Activity was concentrated in six centers; the National Institute of Oncology accounted for 35.99% of cases and the top three providers for 77.63% (HHI=0.241; Gini=0.374). General surgery (27.49%), urology (23.74%), and gynaecology (21.46%) comprised 72.68% of activity. The specialty distribution shifted over time (chi-square: p<0.001). Mean cost-weight per case declined from 9.44 in 2022 to 8.68 in 2025 (p=0.0066).
CONCLUSIONS: Robotic surgery inpatient activity expanded rapidly with moderate-to-high provider concentration and a small but statistically significant shift in specialty mix. To the declining cost-weight per case reflects changing case complexity and the refinement of financing techinique, because since 2022 there was only 1 piece of robotic-surgery related DRG, with the increased involvement of fellow OR-related specialities from May 2025, 9 pieces of specified DRGs were applied more tailored for the mix and need of cost.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HPR21
Topic
Health Policy & Regulatory
Topic Subcategory
Insurance Systems & National Health Care, Public Spending & National Health Expenditures, Reimbursement & Access Policy
Disease
No Additional Disease & Conditions/Specialized Treatment Areas