The hospitals owned by the Municipality of Budapest perform roughly the half of population's medical care of Budapest and Pest county, but they act as a totally independent organisations in the market of healthcare services. In this system it is not possible to make use of scarce resources efficiently, the system cannot work at group optimum. In order to utilise the available sources in an optimal way and form a structure which conforms to the needs, the advisory consortium elaborated an operative holding type function model, which we suggest to introduce according to the principle of gradualism.
The hospitals owned by the Municipality of Budapest perform roughly the half of population's medical care of Budapest and Pest county, but they act as a totally independent organisations in the market of healthcare services. In this system it is not possible to make use of scarce resources efficiently, the system cannot work at group optimum. In order to utilise the available sources in an optimal way and form a structure which conforms to the needs, the advisory consortium elaborated an operative holding type function model, which we suggest to introduce according to the principle of gradualism. In the framework of the project, the concept of healthcare policy of Budapest was also accepted, which replaces the concept approved of in 2002.
The feasibility study and the implementation plan as well as the advisory work were made on the request of the commission of the Municipality of Budapest. The advisory consortium consisted of the following members: GKI Economic Research Co. (leader), Roland Berger Strategy Consultants and TIG-RES Co.
The principles of integration – accepted in the Concept of Healthcare Policy:
The model's essence is that the healthcare system works on group optimum, which has the following key elements:
– centralised strategic management,
– the operative management of medical activity in places where the service is provided,
– centralised financing,
– common purchase,
– unified controlling and information system,
– unified external appearance, advance booking of patients, waiting list management,
– the functional operation of supporting services as shared services,
– efficient utilisation of human and objective resources at group level.
The vision of the model
The vision of provision system's formation is an institutional system working at group optimum, which provides the healthcare services of Budapest at high quality and economically.
The aim of the work concerning the Budapest Healthcare Model is elaborating a model, in which – according to the vision – the hospitals of Budapest
- operate in an optimal structure,
- work with the efficient use of the sources,
- operate with the development of their financial position,
- are transparent and provide high-quality supply which can be reviewed by the patients,
- offer the opportunity of efficient, professional career to their employees
- represent transparent and rational management for the local government.
In order to achieve higher healthcare quality, the focus of the transformation is on the hospital's functional, service and management support, so that they could be able to concentrate better on their basic activity, i.e. on curing and nursing.
The proposed model
Based on international and domestic examples introduced for the solution of similar cases as well as the detailed analysis of the situation, it can be stated, that the integration objectives of the model's vision can be reached through the running of the institutional system in operative management structure most efficiently. The organisational basis of the establishment of the new system is assured by the Municipality of Budapest that founded the Health Centre of Budapest Co. (Fővárosi Egészségközpont Zrt.) in 2008 for this reason.
The Budapest Healthcare Model is about the increase of group-level efficiency, which can be achieved through integration. The formation of the new operation structure takes – even after the creation of the necessary legal background – more years and is a result of a dynamic iteration process between the suitability of the central organisation and the degree of the integration. The aim is to set up such organisational structure, in which
– hospitals can focus on their basic activity, i.e. medical supply,
– the group-level harmonisation of operation, the standardisation of the hospitals' processes are fulfilled by the Health Centre of Budapest Co. through the creation of the entitlement for leading and controlling,
– the necessary conditions for curing are submitted to the hospitals in the framework of divided services, that makes utilisation of reserves arising from economies of scale possible.
The proposed timing of model's realisation
The formation of Budapest Healthcare Model is proposed – following the present one – in three main phases. The changes planned in the different phases of the transformation are based on each other. The single sets of measures yield a result which can be appreciated by themselves, and an emphasised aim is to let the safety of supply not get harmed. The Health Centre Co. and the hospitals will work in a division of labour, which allows the centre to be capable of the supply of common functions. According to this, in the single phases only such tasks can get into the competence of Health Centre, to which the necessary objective and human resources and the organisational, legal and operational conditions are at disposal.
The planned results of reorganisation
It is a fundamental requirement to ensure every patient to get the supply suiting him/her the best with equal chances. In the new operation structure the provision system will be organised according to the following main principles:
- the general insurance of supply through regional hospitals at basic level close to the population, and organising practical co-operation of the family doctor's supply at system level,
- division according to progressivity, concentration on the technology (devices, instruments), the centralisation of specialisation on the single specialities. The concentration of the professional activity brings about the concentration of the personal and objective conditions at the same time.
- aiming for division of labour with service providers maintained by others.
According to the above mentioned three principles an ideal structure can be described, which does not consider the current barriers such ones that cannot be broken down, but formulates the aim that the healthcare provision system of Budapest wishes to reach through continuous and conscious development. The features of the uniform hospital structures are as follows:
- it adapts well to the claims of patients and the provided supply standard is hereby significantly taller, than in the present model,
- it demands less hospital site than the present one,
- it implies less, but significantly better installed progressive supplying places than the present centre of gravity system and is properly articulated according to progressivity
- it operates with lower expenses and more efficiency.
The reorganisation can ensure a favourable financial result already in a year following its introduction compared to the former operation. This is the result of the operation of centralised tasks in a functionalised and size effective way, as well as the formation of reasonable structure and infrastructure.
