The Impact of the COVID-19 Pandemic on the Performance of the Hospital Care System in Romania as Measured Using the Diagnosis-Related Groups (DRGs) Financing Technique
Author(s)
Gyula Jozsef Nagy, MSc, Attila Dénes Orbán, MSc, Árpád Antal, MSc, Edina Eross, MD, Eniko Pap, MD, Attila Vas Tifán, MD, Áron Csaba Jakab, MSc, Imre Boncz, MSc, PhD, MD.
Institute for Health Insurance, University of Pécs, Pécs, Hungary.
Institute for Health Insurance, University of Pécs, Pécs, Hungary.
OBJECTIVES: The COVID-19 pandemic caused significant challenge for hospital care. The aim of our analysis is to determine how the COVID-19 pandemic has affected the performance of Romanian hospitals.
METHODS: National data required for the analysis were selected from the database of the Romanian National Health Insurance Institute (Casa Naţională de Asigurări de Sănătate, CNAS) using active hospital financing data from Diagnosis Related Groups (DRG). The analysis covers the period 2019-2024. We analysed acute hospital case numbers, case-mix index (CMI) and average length of stay.
RESULTS: In Romania, the number of acute hospital cases in 2019, the year before the COVID-19 pandemic, was 3,731,265 cases. The number of acute hospital cases decreased compared to 2019 due to the COVID-19 pandemic: by 38.6% in 2020, by 38.2% in 2021, by 24.5% in 2022, and by 13.6% in 2023. Even after the COVID-19 pandemic, hospital performance in 2024 did not reach the level of 2019, falling 8.2% behind (3,423,837 cases). The national case-mix index was 1.4297 in 2019, which increased significantly due to the COVID-19 pandemic (2020: 1.4700, 2021: 1.5630, 2022: 1.5445, 2023: 1.6136 and 2024: 1.6773). The national average nursing time in 2019 was 5.77 days, which changed significantly due to the COVID-19 pandemic. In 2020 and 2021, the average nursing time increased (2020: 6.17days, 2021: 6.21days) due to the higher care needs of COVID-19 infected patients, however, from 2022 onwards, the average nursing time was lower in all three years (2022: 5.62days, 2023: 5.38days and 2024: 5.28days) than in the pre-COVID-19 year, 2019.
CONCLUSIONS: The COVID-19 pandemic has significantly reduced the number of acute hospital admissions in Romania and has not reached the pre-pandemic level of 2019 in 2024. The increase in length of stay and case-mix index in 2020 and 2021 reflects the response of the hospital system.
METHODS: National data required for the analysis were selected from the database of the Romanian National Health Insurance Institute (Casa Naţională de Asigurări de Sănătate, CNAS) using active hospital financing data from Diagnosis Related Groups (DRG). The analysis covers the period 2019-2024. We analysed acute hospital case numbers, case-mix index (CMI) and average length of stay.
RESULTS: In Romania, the number of acute hospital cases in 2019, the year before the COVID-19 pandemic, was 3,731,265 cases. The number of acute hospital cases decreased compared to 2019 due to the COVID-19 pandemic: by 38.6% in 2020, by 38.2% in 2021, by 24.5% in 2022, and by 13.6% in 2023. Even after the COVID-19 pandemic, hospital performance in 2024 did not reach the level of 2019, falling 8.2% behind (3,423,837 cases). The national case-mix index was 1.4297 in 2019, which increased significantly due to the COVID-19 pandemic (2020: 1.4700, 2021: 1.5630, 2022: 1.5445, 2023: 1.6136 and 2024: 1.6773). The national average nursing time in 2019 was 5.77 days, which changed significantly due to the COVID-19 pandemic. In 2020 and 2021, the average nursing time increased (2020: 6.17days, 2021: 6.21days) due to the higher care needs of COVID-19 infected patients, however, from 2022 onwards, the average nursing time was lower in all three years (2022: 5.62days, 2023: 5.38days and 2024: 5.28days) than in the pre-COVID-19 year, 2019.
CONCLUSIONS: The COVID-19 pandemic has significantly reduced the number of acute hospital admissions in Romania and has not reached the pre-pandemic level of 2019 in 2024. The increase in length of stay and case-mix index in 2020 and 2021 reflects the response of the hospital system.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HPR203
Topic
Epidemiology & Public Health, Health Policy & Regulatory, Health Service Delivery & Process of Care
Topic Subcategory
Insurance Systems & National Health Care, Public Spending & National Health Expenditures
Disease
No Additional Disease & Conditions/Specialized Treatment Areas