Importance of Hospital Performance Indicators in Contracting and Financing Medical Services in Surgical Wards

In the Romanian healthcare system, public hospitals' contract for the provision of healthcare services with the National Health Insurance Services (NHIS) is the main source of revenue in a hospital's income and expenditure budget. In Romania, for acute diseases, payment is made on a per-case basis for hospitals financed under the diagnostic-related groups (DRG) system, which is calculated according to the indicators achieved. The main objective of the study aimed at the quantitative and comparative analysis of hospital performance indicators used in the calculation of the contracted amount with NHIS, in order to quantify the results and evaluate the effectiveness of the measures taken in the surgical wards of the Emergency Clinical County Hospital of Oradea (ECCHO) compared to the annual average values at the national level, in the period 2012-2022. The indicators, such as the number of beds, number of cases, average length of hospitalization (LOH), and case complexity index (CCI), were analyzed at the level of the ECCHO, a tertiary care hospital in the surgical wards. Rehabilitation and modernization of wards, laboratories, operating theatres, and high-performance equipment have been made possible through efficient management and monthly monitoring of medical and financial activity. The average LOH actually carried out on the surgical wards has been decreasing over the 11 years analyzed, with a lower number of hospital days than at the national level. The CCI achieved by the hospital's surgical wards has had an increasing evolution throughout the period analyzed, higher than the national value. The maximum amount contracted and the amount contracted by the hospital is higher when the LOH and CCI indicators achieved by each section are included in the formula than the indicators established at the national level. A lower LOH and a higher CCI than the national values facilitated the contracting of a higher amount. Optimization of the indicators by hospital performance is correlated with improved funding by the NHIS. Increasing the contracted amount facilitates the contracting of an exponential annual number of cases, resulting in more efficient medical services in the surgical wards.