Comparison of DRG system funding and actual costs for intensive care in Hungary

Introduction

Since its introduction in 1993, there has been continuous underfunding of the Heath System in Hungary; it is especially true for expensive specialties, like Intensive Care. In many other countries that use DRG costing, there is individual funding available for ICUs, but it is not the case in Hungary. In this study, we compared actual ICU costs with reimbursed funds during a 1-month period.

Methods

We selected 1 month for which the amount of reimbursed fund was available (August 2001). Retrospectively, we collected the actual variable costs for every patient during that period, using nursing and medical records. These variable costs included drugs, disposables, nutrition, blood and diagnostics. Fixed costs (non-clinical support and personnel) were then calculated with the top-down method. We did not include estate costs in our study as it was proven to show little importance in cost analysis [1]. General patient data, reason for admission, SAPS-II score, length of ICU stay and length of mechanical ventilation were assessed as well. These potential cost indicators were then evaluated to the actual cost of ICU care and reimbursed DRG funds.

Results

There were 12 patients during August 2001, who had been admitted to and discharged from our ICU. The overall costs of these cases were 7.72 M Ft (SD = 0.60 M Ft) and there was only 7.26 M Ft (SD = 0.61 M Ft) refunded to the unit.

The length of stay correlated very well with actual cost (r² = 0.98) and less well with reimbursed DRG funds (r² = 0.75). The length of mechanical ventilation showed better correlation with DRG funding (r² = 0.86), then with actual costs (r² = 0.66). However, there was no correlation between SAPS-II and actual or reimbursed funds (r² = -0.54, -0.08).

Conclusion

The actual cost of Intensive Care was significantly higher then the reimbursed DRG fund given to the unit. In our Health System, DRG refund is supposed to cover estate costs and capital equipment as well. There was a negative balance without including these cost blocks, which highlights the importance of individual funding for Intensive Care. DRG refund was less than actual cost for patients who were not ventilated. Our study confirmed that SAPS II could not be used as a cost indicator.

Table.

	HUF	EURO
Drugs/fluids	981,687	3974	12.70%
Disposables	545,566	2209	7.06%
Nutrition/blood	266,212	1078	3.45%
Clinical support	191,537	775	2.48%
Non-clinical support	1,094,840	4433	14.17%
Personnel	4,648,614	18,820	60.15%
Total cost	7,728,456	31,289	100%