Abstract
BackgroundThe global financial crisis and the economic and financial adjustment programme (EFAP) forced the Portuguese government to adopt austerity measures, which also included the health sector. The aim of this study was to analyse factors associated with HIV/AIDS patients’ length of stay (LOS) among Portuguese hospitals, and the potential impact of the EFAP measures on hospitalizations among HIV/AIDS patients.MethodsData used in this analysis were collected from the Portuguese database of Diagnosis Related Groups (DRG). We considered only discharges classified under MCD 24 created for patients with HIV infection. A total of 20,361 hospitalizations occurring between 2009 and 2014 in 41 public hospitals were included in the analysis. The outcome was the number of days between hospital admission and discharge dates (LOS). Hierarchical Poisson regression model with random effects was used to analyse the relation between LOS and patient, treatment and setting characteristics. To more effectively analyse the impact of the EFAP implementation on HIV/AIDS hospitalizations, yearly variables, as well as a variable measuring hospitals’ financial situation (current ratio) was included.ResultsFor the 5% level, having HIV/AIDS as the principal diagnosis, the number of secondary diagnoses, the number of procedures, and having tuberculosis have a positive impact in HIV/AIDS LOS; while being female, urgent admission, in-hospital mortality, pneumocystis pneumonia, hepatitis C, and hospital’s current ratio contribute to the decrease of LOS. Additionally, LOS between 2010 and 2014 was significantly shorter in comparison to 2009. Differences in LOS across hospitals are significant after controlling for these variables.ConclusionFollowing the EFAP, a number of cost-containment measures in the health sector were implemented. Results from our analysis suggest that the implementation of these measures contributed to a significant decrease is LOS among HIV/AIDS patients in Portuguese hospitals.
Highlights
The global financial crisis and the economic and financial adjustment programme (EFAP) forced the Portuguese government to adopt austerity measures, which included the health sector
Diagnosis Related Groups (DRG) were first introduced in Portuguese hospitals through a pilot study in 1984 and, since the 1990s, DRGs are used for DRG-based hospital budget allocation from the National Health Service (NHS) to hospitals and for DRG-based case payment from third-party payers [28]
During the study period (2009– 2014), there was a steady decrease in the number of hospitalizations (Table 2), while the majority corresponded to urgent admissions (83.4%)
Summary
The global financial crisis and the economic and financial adjustment programme (EFAP) forced the Portuguese government to adopt austerity measures, which included the health sector. Augusto et al BMC Health Services Research (2019) 19:303 aimed at cost containment and increasing efficiency within the Portuguese National Health Service (NHS) [3]. These included severe cuts in the wages of health care worker; the creation and implementation of clinical guidelines; the reorganisation and rationalisation of the hospital network through specialisation and concentration of hospital and emergency services; and setting up a system for comparing hospital performance (benchmarking) [4]. Budget cuts could have led hospitals to reduce inefficiencies and to decrease quality of health care provided (e.g. by reducing length of stay or decreasing the number of admissions)
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