Evaluation of the implementation experiences of the Hungarian integrated care coordination pilot.

Background: Caring for patients with multiple chronic conditions requires integration, but more evidence is needed on what makes reform initiatives work. This study aims to identify and analyse the critical success factors of a Hungarian care coordination experiment (1999-2008).

Methods: The Hungarian Care Coordination System is described and analysed based on three feasibility dimensions: conceptual (problem-based policymaking), technical, and political. Data are from documentary analysis, official statistics and implementation experiences of a care coordinator organisation.

Results: The conceptual and technical feasibility of the pilot is characterised by innovative features: provider and financial incentive (functional integration) based implementation; virtual fundholding; design features, which counterbalance incentives to undertreat, eliminate bankruptcy risks, exclude risk selection practices and ensure easy upscalability; the utilisation of advanced provider payment information systems for monitoring. The conceptual flaw of calculating the virtual budget should have been corrected and the risk of cost increase due to better access and quality could have been addressed. The experiment failed in terms of political feasibility. Better communication, more transparency, systematic monitoring and more frequent evaluation would have been needed.

Discussion: The model did not upset existing arrangements. Efficiency was ensured through a balance of decentralised and centralized functions: care coordination by providers and revenue-generation, pooling, and purchasing by central agencies.

Conclusion: The Hungarian Care Coordination System is a unique health system innovation, still relevant in the current Hungarian context, and for other countries to learn from.