DRG-BASED DIFFUSION OF DAY SURGERY IN HUNGARY: CASE-GROUP AND PROVIDER VARIATION
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: One-day surgery becomes an ever-reliable alternative of the expensive inpatient care in many developed countries worldwide. The aim of the study is to quantify the national diffusion of day-surgery in the publicly funded Hungarian healthcare system and the associated shift from inpatient to day-case care.
METHODS: The study database was derived from the National Directorate General for Hospitals and contained all the cases and DRG cost-weights which were eligible to be treated in day surgery. The study database was for 2014-2025 (October). The analysis covered all the number of cases and DRG cost-weights by the DRG main groups (18 different groups) and 8 type of hospital categories. For each, the calculation of day-surgery penetration (day cases/total), mean DRG cost-weight per case, and concentration of day-surgery volume (Herfindahl-Hirschman Index [HHI], 3-group concentration ratio [CR3], Gini) was delivered. Differences in inpatient versus day-surgery distributions were tested with chi-square (Cramer's V).
RESULTS: Day-surgery penetration varied markedly by DRG main groups from 0.35% (04P; 38/10,971) to 89.54% (02P; 1,216,450/1,358,604); DRG cost-weight penetration ranged from 0.28% (04P; 44.62/15,775.21) to 89.26% (02P; 785,927.12/880,537.89). Day-surgery case volume was concentrated: the top three DRG main group [02P (ophtalomology), 13P (gynecology), 14P (obstetrics)] comprised 59.73% of day-surgery cases (CR3), with HHI=0.183 and Gini=0.671. Inpatient versus day-surgery case-group distributions differed substantially (χ²=2,206,315; df=17; p<0.001; V=0.568). By provider type, penetration ranged from 30.73% in national institutes (163,713/532,690 cases) to 99.65% in dedicated day-surgery centres (314,983/316,085 one-day surgery centers), yet these centres delivered only 9.20% of national day-surgery cases. Provider-type differences were significant (χ²=424,984; df=7; p<0.001; V=0.249).
CONCLUSIONS: Day-surgery diffusion is advanced nationally but highly uneven: a small set of case groups drives most number of cases, and adoption varies widely by provider type. Targeted benchmarking and payment/clinical pathways focused on low-penetration groups could accelerate appropriate substitution while preserving case-mix complexity management.
METHODS: The study database was derived from the National Directorate General for Hospitals and contained all the cases and DRG cost-weights which were eligible to be treated in day surgery. The study database was for 2014-2025 (October). The analysis covered all the number of cases and DRG cost-weights by the DRG main groups (18 different groups) and 8 type of hospital categories. For each, the calculation of day-surgery penetration (day cases/total), mean DRG cost-weight per case, and concentration of day-surgery volume (Herfindahl-Hirschman Index [HHI], 3-group concentration ratio [CR3], Gini) was delivered. Differences in inpatient versus day-surgery distributions were tested with chi-square (Cramer's V).
RESULTS: Day-surgery penetration varied markedly by DRG main groups from 0.35% (04P; 38/10,971) to 89.54% (02P; 1,216,450/1,358,604); DRG cost-weight penetration ranged from 0.28% (04P; 44.62/15,775.21) to 89.26% (02P; 785,927.12/880,537.89). Day-surgery case volume was concentrated: the top three DRG main group [02P (ophtalomology), 13P (gynecology), 14P (obstetrics)] comprised 59.73% of day-surgery cases (CR3), with HHI=0.183 and Gini=0.671. Inpatient versus day-surgery case-group distributions differed substantially (χ²=2,206,315; df=17; p<0.001; V=0.568). By provider type, penetration ranged from 30.73% in national institutes (163,713/532,690 cases) to 99.65% in dedicated day-surgery centres (314,983/316,085 one-day surgery centers), yet these centres delivered only 9.20% of national day-surgery cases. Provider-type differences were significant (χ²=424,984; df=7; p<0.001; V=0.249).
CONCLUSIONS: Day-surgery diffusion is advanced nationally but highly uneven: a small set of case groups drives most number of cases, and adoption varies widely by provider type. Targeted benchmarking and payment/clinical pathways focused on low-penetration groups could accelerate appropriate substitution while preserving case-mix complexity management.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HPR121
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