The effect of performance-volume limit on the DRG based acute care hospital financing in Hungary

Dóra Endrei, Antal Zemplényi, Bálint Molics, István Ágoston, Imre Boncz

Research output: Contribution to journalArticle

21 Citations (Scopus)


Objectives: The aim of our paper is to analyse the effect of the so-called performance volume limit (PVL) financing method on acute hospital care. Data and 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.

Original languageEnglish
Pages (from-to)152-156
Number of pages5
JournalHealth Policy
Issue number2-3
Publication statusPublished - Jan 1 2014



  • Cost containment
  • DRG
  • Health care financing
  • Health insurance
  • Hospital care

ASJC Scopus subject areas

  • Health Policy

Cite this