Has the caveat of case-mix based payment influenced the quality of inpatient hospital care in Portugal?

Portugal was the first country with a national health system to incorporate diagnosis related group (DRG) case-mix adjustment in formulating hospital budgets on a nation-wide basis. Most of the case-mix payment-outcomes literature comes from the USA where the quality of data is superior to that of many other countries. The purpose of this article is to assess the initial impact of case-mix financing on the quality of inpatient care in Portuguese hospitals using a methodology that may be appropriate for health care systems whose information is not as complete as that of the USA. Estimating a count data model at the hospital level with inpatient mortality as a quality indicator, the authors find no evidence that case-mix based payment has had adverse consequences on inpatient mortality for the most frequent non-obstetric DRG during the three year time period under study.