Health Systems in Transition - Hungary - World Health Organization ...

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Health systems in transition Hungary
• The care coordinator (that is, a group of family doctors, a polyclinic or a
hospital) had no financing/budget-holding responsibilities. Retained at the
central level, the financing and payment functions continued to be carried
out by the NHIFA.
• The budget-holding function was virtualized. Although care coordinators
were assigned a budget on the basis of an adjusted capitation formula, the
budget amount was not transferred to the care coordinator’s bank account,
but rather served only a basis for comparison: if the actual spending on
the patients of the population to be cared for was lower than the virtual
budget, only the difference (that is, the savings) was transferred to the
care coordinator, which could subsequently use the money to remunerate
doctors (or other health care providers within the model), or to improve
working conditions, etc.
• Family doctors and not individual inhabitants chose whether to join the
CCS, minimizing the possibility of risk selection.
• Patients retained the right to choose providers freely and could utilize
health care at providers outside the system, but all the payments made to
these providers were deducted from the care coordinator’s virtual budget.
In short, the financial responsibility for all episodes of care of a patient in
the population to be cared for lay with the care coordinator. This limited
incentives to maximize savings by undertreating patients.
• Incentives to undertreat patients were also limited by the fact that
providers within the model still had to generate enough revenue by
treating patients to survive month by month till the end of the year, when
the income from the savings could be realized.
• The NHIFA provided access for the care coordinators to the health care
utilization data of patients in their respective populations to be cared
for. This database provided the unique opportunity to analyse practice
patterns, protocol compliance, patient pathways at the level of individuals,
and to evaluate the impact of interventions implemented by the care
coordinator retrospectively.
• The pilot did not change how the system operates. If anything went wrong,
the care coordination function could be withdrawn, without any risk of
people remaining without adequate care.
By design, the CCS assumed the cooperation of local health care providers,
that is, the establishment of a functional network of primary care doctors,
outpatient specialist clinics and hospitals. When family doctor groups served