Administrative changes in DRG-based financing models in Portugal

Introduction In the last few years, the use of DRG in the model adopted to finance Portuguese hospitals has been subject to an extensive debate. In order to decide on the best method to achieve the desired efficiency goals, players in the healthcare system have carried out a wide debate to identify whether or not efficiency incentives exist in the adopted model. This discussion, in an effort to design a comprehensive analysis, also allows one to integrate both the financing model and performance measurement methods. Important features of the Portuguese financing model are: i) Equivalent Patients, a payment unit for production (i.e., quantity); and ii) Case-mix indexes (CMI), a measure of the complexity of in-patient episodes treated in the hospital in terms of resource consumption (i.e., price). Administrative changes in these variables promote changes in hospital behaviour.