In Hungary, the healthcare system's excessive reliance on hospital care often results in avoidable admissions for services better suited to outpatient settings. Recognizing this, the Hungarian Government has, in recent years, introduced wide-ranging reforms to emphasize efficient, patient-centred care, particularly through enhancing primary care. These reforms include measures to refine payment systems for health service providers and to strengthen organizational and clinical governance frameworks, with the goal of developing a healthcare model characterized by more effective clinical management as well as patient safety and quality control.[1][2][3][4] In view of this, the Government has started piloting bundled payment methods for Chronic Obstructive Pulmonary Disease (COPD) treatment. This new and innovative approach consolidates payments for both hospital and ambulatory care into a singular, comprehensive fee that spans the entirety of a patient's care journey, thus driving system-wide efficiency and cost-effectiveness. Supported by the European Commission's Directorate General for Structural Reform Support (DG REFORM) and WHO's technical assistance, the Hungarian Government tested this method through an operational study from November 2021 to December 2023 involving 2000 COPD patients across four counties. This pilot has resulted in reduced hospitalization rates, improved patient communication tools, and strengthened focus on patient adherence to treatment plans. These achievements align with WHO’s European Programme of Work 2020-2025 [5], emphasizing the importance of integrating primary, ambulatory, and hospital care to ensure a patient-centred approach to service delivery. This approach is also an example of WHO’s enhanced support to Member States, as agreed in “Delivering United Action for Better Health – a strategy for collaboration between the WHO Regional Office for Europe and Member States in the WHO European Region,” leveraging skills, knowledge and expertise to inform national initiatives.

How did Hungary, with the support of WHO, achieve this?

The Government of Hungary sought to shift from a traditional hospital-centric model to a patient-oriented ambulatory care model, aiming to enhance patient experiences by reducing hospital stays, offering treatments closer to patients' homes, promoting close follow up through ambulatory care units, and enhancing communication. To facilitate this pivotal transformation, WHO Hungary, with support from national health authorities and DG REFORM funding, gathered a team of both national and international experts, equipped to offer high-level technical expertise and guidance to present international good practice and evidence. This collaborative effort resulted in the establishment of a strategic alliance with Hungary’s National Working Group, encompassing crucial stakeholders such as the State Secretariat for Health, the Korányi National Institute of Pulmonology, and representatives from hospitals, whose participation in the project laid the groundwork for a more integrated and patient-focused health care system.

Clinical governance refers to the systems, processes, and culture needed to ensure the delivery of high-quality health care. Following a thorough evaluation of the country’s clinical governance framework, WHO Hungary, in close coordination with WHO Regional Office for Europe, offered recommendations for its improvement. Through a series of meetings, presentations, technical workshops, and the deployment of innovative communication tools, the team shared and applied best practices and international evidence. This collaborative effort culminated in a proposal for a bespoke governance framework for Hungary and a clear conceptual framework for bundled payment, aimed at enhancing the quality and efficiency of health care services by seamlessly integrating clinical management and health financing.

^{A nurse demonstrates the correct use of the inhaler in Szolnok, Hungary, 2023.}
Photo credit: WHO Hungary

This innovative approach combining clinical governance and health financing aims to streamline payments and care coordination, encouraging more effective and patient-focused health care practices. To enable its implementation, WHO also spearheaded comprehensive training for health care professionals across four pilot sites, developing training materials, curricula, and overseeing funding, coordination, and mentorship.

“Thanks to the communication training I've improved a lot, it's important for me to be aware of the use of communication tools.” 

– Medical Doctor after completing the communications training, 14 December 2022