Hungarian Managed Care initiatives between 2000 and 2007: regional health outcomes of the Hungarian Care Organizations

BACKGROUND: In Hungary, since 1990, each government has tried to transform and rationalize the structure of health care. One of the reforms was the Care Managing Organization (CMO) programme introduced in 1999. OBJECTIVES: The aim of this paper is to describe the regional, environmental, structural and preliminary health related outcomes of the CMO in Bács-Kiskun County (Central-Eastern Hungary). METHODS: First, cardiovascular screening programmes were organized for pre-screened and randomly selected populations of a total of 4462 persons. Seven years after completing the programmes, regional mortality data were analysed and compared. Second, nutritional and lifestyle counselling programmes with increased physical activity were organized for 2489 overweight or obese patients from the participating primary care practices. Anthropometric and laboratory data were examined after one and two years. RESULTS: First, for persons with higher cardiovascular risk, appropriate medical treatment was introduced, and after seven years, their mortality rates proved better than the regional and national data. Second, almost all measured anthropometric parameters improved (body mass index, body weight decrease) after the first year and this trend lasted till the end of the second year. CONCLUSIONS: According to the data of the National Health Insurance Fund, the average savings rate for all CMOs for the fiscal years 1999–2007 was 4.94%. The highest rates of savings were realized in chronic and acute inpatient care and medical devices. In the end of 2008, by which time 14 CMOs had already covered 2.1million people, the programme was discontinued by the government, without a comprehensive evaluation of the experience and outcomes.