Introduction: The study of funding systems is an important issue that can influence the quality of care provided. According to some authors the structure of any funding system usually involves the definition of the produced quantity and respective prices, and it is also defended that the health organizations make their productive structure and their strategic decisions dependent of the price system applied. Currently the Portuguese funding system is based on the total number of acts and services provided, based on a price basis to be adopted annually by the Ministry of Health. The main production lines defined are: inpatient (medical and surgical), ambulatory visits, emergency visits, day hospital, home care services and continuing care (convalescence and palliative). Hospitals are grouped according to their characteristics and there is a price per unit of production defined for each group. The case-mix index (CMI) from the previous year is used to consider the differences among hospitals belonging to the same group. Additionally, in order to encourage the achievement levels of activity contracted, the contractor may establish rules of remuneration of marginal production (activity above or below the levels fixed by contract). Objectives: This study aims to assess and quantify the differences between the amount of funding expected and actually received for a group of Portuguese hospitals, for each of the main production lines considered, and to determine its impact on hospitals’ profits. Methods: For a 31 public hospitals sample, we considered that the following variables determined the value of funding: volume, weight of each production line, CMI and price. Then we: (1) compared the global values of real and expected funding (also simulating an adjustment of the case-mix index used to calculate the expected value); (2) compared the real value and the expected value for each production line, and their repercussions on the total funding. Each of the variables that impacted total funding was changed in part and sequentially, whereas the other remained constant. Results: The comparison of the real CMI with the CMI expected showed that hospitals respond in different ways to incentives in the funding model. There were differences between the patterns observed in inpatient and ambulatory department, as well as by type of treatment (medical / surgical). The analysis by hospital identified a group of hospitals whose behavior typifies the possible reactions to the funding model implemented. Conclusions: Considering the potential incentives contained in a financing method, there seems to be possible adjustments made by hospitals that can influence the amount of funding received. The results show the importance of monitoring budgetary deviations, particularly revenues, both in the perspective of providers as well as the central authorities responsible for funding.

--

Health funding, Portugal, Hospitals