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

Health systems in transition Hungary 175
as a care coordinator, the population receiving coordinated care automatically
consisted of the people who were registered with the family doctors within the
group. When other providers, such as polyclinics or hospitals, served as a care
coordinator, they first had to contract with local family doctors to bring their
registered patients into the model. Naturally, all three types of care coordinators
had to contract with other health care providers in their region in order to
realize maximum efficiency improvements. These contracts were based on
the sharing of these savings among providers within the model. Importantly,
provider networks were formed only within the health care system, as social
care was not part of the initiative.
The first wave of the CCS project was launched in July 1999 with nine care
coordinator organizations. The largest organization, the Misszió non-profitmaking
corporation (a polyclinic) based in the city of Veresegyház, covered
a population of 240 000 in 2003. The part of the total population of Hungary
that could be drawn into the pilot was expanded gradually. By 2005 the project
covered more than 20% of the Hungarian population, or some 2.2 million
inhabitants, and the system was regulated in detail (2005/12).
After plans were introduced in 2006 to privatize parts of the SHI system and
entrust competing private health insurance companies with the care coordination
function, the CCS was assigned low priority. Although the privatization plan
was ultimately unsuccessful (see subsection A third attempt to introduce
managed competition to the SHI system in section 6.1.1), the CCS remained a low
priority and was eventually eliminated in December 2008 (2008/9). Although
ample data were available considering that the CCS had been in operation for
10 years, this decision was not based on the results of a scientific evaluation.
Moreover, there was no evidence of worsening health outcomes, of problems
with access to care, or of inefficiencies or any malfunctions in general. On the
contrary, published assessments of the CCS show that many care coordinators
employed a range of case and disease management techniques, none of which
were enforced, prescribed or suggested any way by the Ministry of Health 1 or
the NHIFA. Rather, the application of these techniques appears to have been
motivated by the financial incentives inherent in the system – that is, the ability
to take the savings resulting from improved coordination in care and use these
to remunerate providers.
1 As of 2010 called the State Secretariat for Healthcare within the Ministry of National Resources.