Presentation (CTI)

OBJECTIVES: The Diagnosis Related Groups (DRG)-based hospital financing system was introduced in Romania in 2013. Our objective was to examine the impact of DRG implementation on the efficiency of Romanian hospitals.
METHODS: We used data from the Romanian National Health Insurance House (Casa Naţională de Asigurări de Sănătate, CNAS) covering the period 2013-2023. The analysis focused on hospital financing data based on DRG-system. We examined the number of acute and chronic hospital cases and their average length of stay. County level regional inequalities were assessed according to the permanent address of the patients.
RESULTS: In 2013, the number of acute hospital cases was 4,106,211, which continuously declined over the years. Chronic hospital cases numbered 357,565 in 2013, which continuously increased to 418,406 by 2019, then decreased from 2020. We found notable regional differences: in 2023, based on the patient address, Hunedoara, Caras-Severin and Gorj had the highest case rates (2104, 2095 and 2003 cases per 10,000 inhabitants), while Arad, Ilfov, Bistrita-Nasaud and Vrancea counties had the lowest (1349, 1412, 1422 and 1453 cases per 10,000 inhabitants). The average annual length of stay for acute cases decreased from 7.09 days per patient in 2013 to 5.82 days in 2023. For chronic cases, the average length of stay was 18.91 days in 2013 and remained mostly stable, except during the COVID period when it rose to 31.79 days, then declined to 20.58 days by 2023.
CONCLUSIONS: After DRG implementation in Romania, both the number of acute hospital cases and their average length of stay decreased significantly. In contrast, chronic hospital cases increased, while the average length of stay for chronic care remained relatively unchanged over the study period.