Az indikátoralapú teljesítményértékelésre épülő forráselosztás hatékonysága Magyarországon a felnőtteket ellátó háziorvosi praxisokban

Translated title of the contribution: Resource allocation effectiveness of indicator-based performance monitoring in Hungarian primary care for adults

Anita Pálinkás, Nóra Kovács, Valéria Sipos, Ferenc Vincze, Magor Papp, Árpád Czifra, R. Ádány, J. Sándor

Research output: Contribution to journalArticle

Abstract

Introduction: The indicator-based performance monitoring and pay-for-performance system for Hungarian primary care was established in 2009, covering the whole country. It is based on a stable legal system and well operating information technology. Although, the health insurance system is able to facilitate the performance improvement only by the financing for general medical practices, the many times modified present system does not take into consideration (apart from the geographical location of practices) factors which determine the performance but cannot be influenced by general practitioners. Aim: The study aimed at renewing the indicator set and evaluation methodology in order to enable the monitoring to evaluate the performance of general medical practices independent of their structural characteristics. Method: Each adult care specific primary care performance indicator from June 2016 covering the whole country has been investigated. Indicators adjusted for structural practice characteristics (age and gender of patients; relative education of people provided; settlement type and county of the practice) have been computed. The difference between adjusted indicators and national reference values has been evaluated by statistical testing. Appropriateness of the present monitoring and financing system has been investigated by comparing the practice level presently applied and adjusted indicators to outline the opportunities to develop the present system. Results: The present monitoring allocates 34.46% of pay-for-performance resources for improving the performance of practices. The majority of resources supports the conservation of performance. Furthermore, the present system is not able to identify each practice with better than reference performance, withholding amount corresponding to 8.83% of pay-for-performance resources. If this financing were restricted to practices with significantly better than reference performance, the maximum of the financing a month in a practice would increase from 176 042 HUF (551 EURO) to 406 604 HUF (1274 EURO). Conclusion: Completing the performance monitoring system operated at present by the National Health Insurance Fund of Hungary with indicators adjusted for structural characteristics of the general medical practices, the resource allocation effectiveness could be improved. Orv Hetil. 2019; 160(39): 1542-1553.

Original languageHungarian
Pages (from-to)1542-1553
Number of pages12
JournalOrvosi hetilap
Volume160
Issue number39
DOIs
Publication statusPublished - Sep 1 2019

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Incentive Reimbursement
Resource Allocation
General Practice
Primary Health Care
Hungary
National Health Programs
Health Insurance
General Practitioners
Reference Values
Technology
Education

ASJC Scopus subject areas

  • Medicine(all)

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Az indikátoralapú teljesítményértékelésre épülő forráselosztás hatékonysága Magyarországon a felnőtteket ellátó háziorvosi praxisokban. / Pálinkás, Anita; Kovács, Nóra; Sipos, Valéria; Vincze, Ferenc; Papp, Magor; Czifra, Árpád; Ádány, R.; Sándor, J.

In: Orvosi hetilap, Vol. 160, No. 39, 01.09.2019, p. 1542-1553.

Research output: Contribution to journalArticle

Pálinkás, Anita ; Kovács, Nóra ; Sipos, Valéria ; Vincze, Ferenc ; Papp, Magor ; Czifra, Árpád ; Ádány, R. ; Sándor, J. / Az indikátoralapú teljesítményértékelésre épülő forráselosztás hatékonysága Magyarországon a felnőtteket ellátó háziorvosi praxisokban. In: Orvosi hetilap. 2019 ; Vol. 160, No. 39. pp. 1542-1553.
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abstract = "Introduction: The indicator-based performance monitoring and pay-for-performance system for Hungarian primary care was established in 2009, covering the whole country. It is based on a stable legal system and well operating information technology. Although, the health insurance system is able to facilitate the performance improvement only by the financing for general medical practices, the many times modified present system does not take into consideration (apart from the geographical location of practices) factors which determine the performance but cannot be influenced by general practitioners. Aim: The study aimed at renewing the indicator set and evaluation methodology in order to enable the monitoring to evaluate the performance of general medical practices independent of their structural characteristics. Method: Each adult care specific primary care performance indicator from June 2016 covering the whole country has been investigated. Indicators adjusted for structural practice characteristics (age and gender of patients; relative education of people provided; settlement type and county of the practice) have been computed. The difference between adjusted indicators and national reference values has been evaluated by statistical testing. Appropriateness of the present monitoring and financing system has been investigated by comparing the practice level presently applied and adjusted indicators to outline the opportunities to develop the present system. Results: The present monitoring allocates 34.46{\%} of pay-for-performance resources for improving the performance of practices. The majority of resources supports the conservation of performance. Furthermore, the present system is not able to identify each practice with better than reference performance, withholding amount corresponding to 8.83{\%} of pay-for-performance resources. If this financing were restricted to practices with significantly better than reference performance, the maximum of the financing a month in a practice would increase from 176 042 HUF (551 EURO) to 406 604 HUF (1274 EURO). Conclusion: Completing the performance monitoring system operated at present by the National Health Insurance Fund of Hungary with indicators adjusted for structural characteristics of the general medical practices, the resource allocation effectiveness could be improved. Orv Hetil. 2019; 160(39): 1542-1553.",
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AU - Kovács, Nóra

AU - Sipos, Valéria

AU - Vincze, Ferenc

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KW - indikátorok

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KW - primary care

KW - teljesítményértékelés

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