PERSISTENT CONCENTRATION AND RISING CASE COMPLEXITY IN HUNGARIAN DAY SURGERY: A TEN-YEAR NATIONAL ANALYSIS (2014-2024)
Author(s)
Róbert Pónusz, MSc, PhD1, Dalma Pónusz-Kovács, MSc2, Csaba Könczei, MSc2, Kristóf Mangel, MSc3, Attila Vas Tifán, MD, MSc2, Imre Boncz, MSc, PhD, MD1.
1Institute for Health Insurance, University of Pécs, Faculty of Health Sciences, Pécs, Hungary, 2Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary, 3Legal department, National Directorate General for Hospitals, Budapest, Hungary.
1Institute for Health Insurance, University of Pécs, Faculty of Health Sciences, Pécs, Hungary, 2Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary, 3Legal department, National Directorate General for Hospitals, Budapest, Hungary.
OBJECTIVES: Day surgery adoption in Hungary remains uneven across providers and specialties. Whether activity is concentrating further, whether low-volume specialties are catching up, and what drives the observed rise in case complexity are poorly understood. We assessed concentration trends, convergence patterns and the sources of case-mix change in publicly funded day surgery over a full decade.
METHODS: We analysed the complete National Directorate General for Hospitals dataset covering all day-surgery-eligible cases and their DRG cost-weights for 2014-2024. Annual volumes were stratified by hospital type and specialty. Concentration was quantified using the Herfindahl-Hirschman Index (HHI), three-firm concentration ratio (CR3) and Gini coefficient. To test whether smaller specialties were catching up, we estimated beta-convergence by regressing annualised growth on baseline log-volume, and tracked sigma-convergence through the cross-sectional dispersion of log-volumes. Changes in the national case-mix index (CMI) were decomposed via shift-share analysis into within-specialty and between-specialty components.
RESULTS: Concentration remained persistently high: the specialty-level Gini was 0.829 in both 2014 and 2024, while provider HHI edged from 0.212 to 0.219. No meaningful catch-up occurred (β = −0.019; p = 0.092) and log-volume dispersion stayed flat, pointing to entrenched inequality. National CMI rose from 0.547 to 0.729 (+33.3%). Shift-share decomposition attributed 63.5% of this increase to growing within-specialty complexity and 36.5% to compositional shifts toward heavier specialties, notably cardiology (volume share 5.5% to 7.6%; CMI 1.155 to 1.457). Complexity was highest in church-operated hospitals (CMI 0.910) and national institutes (0.838), lowest in municipal hospitals (0.547), yet between-provider variation narrowed (CV 0.227 to 0.172).
CONCLUSIONS: A decade of data reveals a locked-in market structure with no convergence among specialties, while rising complexity is driven overwhelmingly from within rather than by case-mix reshuffling. Targeted incentives for low-volume specialties and systematic monitoring of complexity-driven cost growth should be policy priorities.
METHODS: We analysed the complete National Directorate General for Hospitals dataset covering all day-surgery-eligible cases and their DRG cost-weights for 2014-2024. Annual volumes were stratified by hospital type and specialty. Concentration was quantified using the Herfindahl-Hirschman Index (HHI), three-firm concentration ratio (CR3) and Gini coefficient. To test whether smaller specialties were catching up, we estimated beta-convergence by regressing annualised growth on baseline log-volume, and tracked sigma-convergence through the cross-sectional dispersion of log-volumes. Changes in the national case-mix index (CMI) were decomposed via shift-share analysis into within-specialty and between-specialty components.
RESULTS: Concentration remained persistently high: the specialty-level Gini was 0.829 in both 2014 and 2024, while provider HHI edged from 0.212 to 0.219. No meaningful catch-up occurred (β = −0.019; p = 0.092) and log-volume dispersion stayed flat, pointing to entrenched inequality. National CMI rose from 0.547 to 0.729 (+33.3%). Shift-share decomposition attributed 63.5% of this increase to growing within-specialty complexity and 36.5% to compositional shifts toward heavier specialties, notably cardiology (volume share 5.5% to 7.6%; CMI 1.155 to 1.457). Complexity was highest in church-operated hospitals (CMI 0.910) and national institutes (0.838), lowest in municipal hospitals (0.547), yet between-provider variation narrowed (CV 0.227 to 0.172).
CONCLUSIONS: A decade of data reveals a locked-in market structure with no convergence among specialties, while rising complexity is driven overwhelmingly from within rather than by case-mix reshuffling. Targeted incentives for low-volume specialties and systematic monitoring of complexity-driven cost growth should be policy priorities.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EPH157
Topic
Epidemiology & Public Health, Health Policy & Regulatory
Topic Subcategory
Public Health
Disease
No Additional Disease & Conditions/Specialized Treatment Areas