Conscious selection of pharmaceuticals, resulting in a systematic formulary for drug distribution management, is critical so that a clinic can focus on procuring and prescribing the most needed medications. This selection process using the WHO Model List and a public-health approach to drug management could serve as a private clinic model for pharmaceutical optimization and targeted international drug donations in sub-Saharan Africa and other resource limited settings.
A71OBJECTIVES: Diagnosis related groups (DRG) like financing method was introduced in Hungary in 1993 for acute care hospital reimbursement. Due to the increased activity of the hospitals, an upper ceiling, the so called performance volume limit (PVL) was introduced in acute care hospital financing in 2006. The aim of our study was to analyze the effect of performance volume limit on DRG based hospital financing on the example of a Hungarian tertiary teaching hospital, the Clinical Centre of the University of Pécs. METHODS: Data derived from the financial database of the National Health Insurance Fund Administration, the only health care financing agency in Hungary. We analyzed the annual DRG based health insurance revenues with and without performance volume limit ceiling. We calculated the proportion of hospital activity over that ceiling measured by DRG cost-weights. The period 2007-2013 was involved into the study. RESULTS: We found a significant loss in DRG reimbursement due to performance volume limit. The annual loss in DRG reimbursement varied between 2.4-10.5 million USD between 2007-2013. The highest revenue loss was observed in 2009, and after 2009 the financial loss decreased to 7.0 (2010), 5.2 (2011), 3.0 (2012) and 2.8 (2013) million USD. This annual revenue loss represented 3.0-14.9 % of the annual revenues of the Clinical Centre of the University of Pécs. CONCLUSIONS: The introduction of performance volume limit into the DRG based hospital financing resulted in a partial loss of hospitals' revenues. The Clinical Centre of the University of Pécs experienced significant loss its revenues due to this regulation.
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