title: The effect of performance-volume limit on the DRG based acute care hospital financing in Hungary.
abstract: OBJECTIVE
  The aim of our paper is to analyse the effect of the so-called performance volume limit (PVL) financing method on acute hospital care.
  
  
  METHODS
  The data were derived from the nationwide administrative dataset of the National Health Insurance Fund Administration (OEP) covering the period 2003-2008. We analysed the trends in the DRG cost-weights, number of cases, case-mix, and average length of stay. We calculated the average annual reimbursement rate per DRG cost-weight with and without the application of PVL degression according to the hospital type and medical professions.
  
  
  RESULTS
  Our results showed that although the national case mix (i.e., the sum of all of the DRG cost-weights produced in one year) did not change between 2003-2006, the trend of the annual number of cases increased, and the average length of stay decreased. During 2007-2008, a significant decline was found in each indicator. The introduction of the PVL resulted in a health insurance budget saving of 1.9% in 2004, 2.6% in 2005, 3.4% in 2006, 5.6% in 2007, and 3.2% in 2008. We found the lowest reimbursement rate per DRG cost-weight at the university medical schools (HUF 138,200 or € 550) and children's hospitals (HUF 132,547 or € 528), whereas the highest was at the county hospitals (HUF 143,451 or € 571) and city hospitals (HUF 142, 082 or € 565).
  
  
  CONCLUSIONS
  The implementation of the PVL reduced the acute care hospital activity and reimbursement. The effect of the PVL was different on the different types of hospitals, and it had a serious disadvantageous effect on the university medical schools and children's hospitals.
authors.affiliation: University of Pécs, Clinical Center, Pécs, Hungary; University of Pécs, Faculty of Health Sciences, Institute for Health Insurance, Pécs, Hungary.
authors.forename: Dóra
authors.initials: D
authors.lastname: Endrei
authors.affiliation: University of Pécs, Clinical Center, Pécs, Hungary; University of Pécs, Faculty of Health Sciences, Institute for Health Insurance, Pécs, Hungary.
authors.forename: Antal
authors.initials: A
authors.lastname: Zemplényi
authors.affiliation: University of Pécs, Faculty of Health Sciences, Institute for Health Insurance, Pécs, Hungary.
authors.forename: Bálint
authors.initials: B
authors.lastname: Molics
authors.affiliation: University of Pécs, Faculty of Health Sciences, Institute for Health Insurance, Pécs, Hungary.
authors.forename: István
authors.initials: I
authors.lastname: Agoston
authors.affiliation: University of Pécs, Faculty of Health Sciences, Institute for Health Insurance, Pécs, Hungary. Electronic address: imre.boncz@etk.pte.hu.
authors.forename: Imre
authors.initials: I
authors.lastname: Boncz
mesh_terms: D000046:Academic Medical Centers / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D003422:Critical Care / Q000191:economics* / Q000458:organization & administration / Q000706:statistics & numerical data; D003953:Diagnosis-Related Groups / Q000191:economics* / Q000706:statistics & numerical data; D005377:Financial Management, Hospital / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D006291:Health Policy / Q000191:economics; D006776:Hospitals, Pediatric / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D006814:Hungary; D007348:Insurance, Health / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D012051:Reimbursement Mechanisms / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data
keywords: Cost containment; DRG; Health care financing; Health insurance; Hospital care