Imre Boncz1, Tamás Evetovits2, Csaba Dózsa3, Andor Sebestyén4, László Gulácsi5, István Ágoston6, Dóra Endrei6, Tímea Csákvári6, Thomas E Getzen7. 1. Faculty of Health Sciences, Institute for Health Insurance, University of Pécs, Pécs, Hungary. Electronic address: imre.boncz@etk.pte.hu. 2. WHO Barcelona Office for Health Systems Strengthening, Division of Health Systems and Public Health, WHO Regional Office for Europe, Barcelona, Spain. 3. Health Care Faculty, University of Miskolc, Miskolc, Hungary. 4. Faculty of Health Sciences, Institute for Health Insurance, University of Pécs, Pécs, Hungary; South-Transdanubian Regional Office, National Health Insurance Fund Administration, Pécs, Hungary. 5. Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary. 6. Faculty of Health Sciences, Institute for Health Insurance, University of Pécs, Pécs, Hungary. 7. Risk, Insurance, and Healthcare Management Department, Temple University, Philadelphia, PA, USA.
Abstract
OBJECTIVES: The aim of this article was to provide a description of the Hungarian care managing organization (CMO) pilot program and its environment, incentive structure, and preliminary outcomes. The need to change the behavior of doctors to increase the effectiveness and cost-effectiveness of the system was the key rationale for the Hungarian CMO pilot program. METHODS: After an application process, nine CMOs were entitled to enter into the system in July 1999. By 2006, there were 14 CMOs covering 2.1 million people. The Hungarian CMO program tried to combine the advantages of both the US managed care programs and the UK general practitioner fundholding system, within the constraints and opportunities of a Central-European country committed to a single-payer health insurance system. RESULTS: The revenue of CMOs derived from a risk-adjusted capitation. The capitation formula was weighted only by age and sex. The expenditures of the CMOs included all the health expenditures on their patients that occurred in any part of the health care system. The average savings rate for all CMOs for the fiscal years 1999 to 2007 was 4.94%. The highest rates of savings were realized in chronic and acute inpatient care and medical devices. The pilot was discontinued in 2008 without a comprehensive evaluation of the experience. CONCLUSIONS: We can conclude that this pilot had a significant contribution to the modernization of the Hungarian health care system.
OBJECTIVES: The aim of this article was to provide a description of the Hungarian care managing organization (CMO) pilot program and its environment, incentive structure, and preliminary outcomes. The need to change the behavior of doctors to increase the effectiveness and cost-effectiveness of the system was the key rationale for the Hungarian CMO pilot program. METHODS: After an application process, nine CMOs were entitled to enter into the system in July 1999. By 2006, there were 14 CMOs covering 2.1 million people. The Hungarian CMO program tried to combine the advantages of both the US managed care programs and the UK general practitioner fundholding system, within the constraints and opportunities of a Central-European country committed to a single-payer health insurance system. RESULTS: The revenue of CMOs derived from a risk-adjusted capitation. The capitation formula was weighted only by age and sex. The expenditures of the CMOs included all the health expenditures on their patients that occurred in any part of the health care system. The average savings rate for all CMOs for the fiscal years 1999 to 2007 was 4.94%. The highest rates of savings were realized in chronic and acute inpatient care and medical devices. The pilot was discontinued in 2008 without a comprehensive evaluation of the experience. CONCLUSIONS: We can conclude that this pilot had a significant contribution to the modernization of the Hungarian health care system.
Authors: Róbert Pónusz; Dóra Endrei; Dalma Kovács; Evelin Pónusz; Bence Kis Kelemen; Diána Elmer; Noémi Németh; András Vereczkei; Imre Boncz Journal: BMC Health Serv Res Date: 2022-06-20 Impact factor: 2.908