Do budget constraints limit access to health care? Evidence from PCI treatments in Hungary

András Kiss (), Norbert Kiss and Balázs Váradi
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András Kiss: KYOS Energy Consulting
Norbert Kiss: Corvinus University of Budapest

International Journal of Health Economics and Management, 2023, vol. 23, issue 2, No 6, 302 pages

Abstract: Abstract Under Hungary’s single payer health care system, hospitals face an annual budget cap on most of their diagnoses-related group based reimbursements. In July 2012, percutaneous coronary intervention (PCI) treatments of acute myocardial infarction were exempted from that hospital level budget cap. We use countrywide individual-level patient data from 2009 to 2015 to map the effect of such a quasi-experimental change in monetary incentives on health provider decisions and health outcomes. We find that direct admissions into PCI-capable hospitals increase, especially in central Hungary, where there are several hospitals which can compete for patients. The proportion of PCI treatments at PCI-capable hospitals, however, does not increase, and neither does the number of patient transfers from non-PCI hospitals to PCI-capable ones. We conclude that only patient pathways, plausibly influenced by hospital management, were affected by the shift in incentives, while physicians’ treatment decisions were not. While average length of stay decreased, we do not find any effect on 30-day readmissions or in-hospital mortality.

Keywords: Hospital funding; Budget cap; Physician agency; Acute myocardial infarction (search for similar items in EconPapers)
JEL-codes: I11 I18 (search for similar items in EconPapers)
Date: 2023
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DOI: 10.1007/s10754-023-09349-w

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