[Improving the quality of COPD treatment by bundled payment method: lessons from a national pilot program].

Abstract

Introduction: In bundled payment, the costs of the entire treatment of a disease – including diagnostic, therapeutic, rehabilitation and care events – are determined and paid by the financer in an average amount. Bundled payment can be a suitable financing method for, e.g., chronic obstructive pulmonary disease (COPD) to make care more patient-centerd and shift towards care based primarily on outpatient care. Objective: The aim of this study is to describe the demographic characteristics of COPD patients enrolled in the COPD Bundled Payment (CKF) Program, the trends in acute exacerbations and in the number of outpatient hospitalizations and outpatient care events due to COPD, compared to conventional COPD care. Method: The Program ran from 01. 11. 2021 to 31. 12. 2023 in four care centers. Patients were enrolled based on reporting to the National Health Insurance Fund of Hungary with a principal diagnosis of COPD (ICD J43–44) in the first 12 months. The involved patients (n = 2079) were followed up for 12 months (n = 2021). Their demographic characteristics, quality of life according to the COPD Assessment Test (CAT), incidence of exacerbations and hospitalization were analyzed by descriptive methods. Data were compared with national data for 2019 and the follow-up year. Results: The largest proportion of patients followed (35.8%) belonged to the Győr center, the majority were male (53%), aged 60–79 years (72%), and 27% were highly symptomatic according to the CAT. During the follow-up period, acute exacerbation of COPD was subjectively assessed in 30% of the included patients, compared to 20.8% by the objective method, and 22.4% among COPD patients in conventional care. The hospitalization rate for COPD was 7.2% among the participants in the Program, compared to 9% nationally. The average number of outpatient visits for COPD patients during the Program was 2.53, compared to 2.34 nationally. Conclusion: Although there were slightly more outpatient visits compared to the national data due to increased care in the Program, we observed a decreasing rate of COPD exacerbations and hospitalizations. Our results suggest that bundled payment may be a simpler and more appropriate financing method for COPD in the future, and could encourage healthcare providers to be more cost-effective, while maintaining adequate patient safety. Orv Hetil. 2025; 166(33): 1302–1311.