Impact of changes of hospital integrations spanning a decade in Hungary: Modern diagnostic services: CT care based on a Hungarian sample

Abstract

Introduction, purpose of the study: In Central Europe, in Hungary, the state guarantees access to health care and basic health services partly through the Semmelweis Plan adopted in 2011. The Health Plan aims to optimize and transform the health system. The objectives of hospital integration, as set out in the Plan, started with the state ownership of municipal hospitals in 2012, continued with the launch of integration processes in 2012–2013 and culminated today. The transformation of a health system can have an impact on health services and thus on meeting the needs of the population. We aim to study the effectiveness of integration through access to CT diagnostic testing. Our hypothesis is that integration has resulted in increased access to modern diagnostic services. The specialty under study is computed tomography (CT) diagnostic care. Our research shows that the number of people receiving CT diagnostic care has increased significantly because of integration, which has also brought a number of positive benefits, such as reduced health inequalities, reduced travel time, costs and waiting lists. Test material and method: Our quantitative retrospective research was carried out in the hospital of Kalocsa through document analysis. The research material was comparing two time periods in the Kalocsa site of Bács-Kiskun County, Southern Hungary. The number of patients attending CT examinations by area of duty of care according to postal codes was collected: Pre-integration period 2014.01.01–2017.11.30. (Kalocsa did not have CT equipment, so patients who appeared in Kecskemét Hospital but were under the care of Kalocsa), post-integration period 2017.12.01–2019.12.31. (period after the installation of CT in Kalocsa). The target group of the study consisted of women and men together, aged 0–99 years, who appeared for a CT diagnostic examination. The study sample size was 6721 persons. Linear regression statistics were used to evaluate the results. Based on empirical experience, a SWOT analysis was carried out to further investigate the effectiveness of integration. Results: As a result of the integration, the CT scan machine purchased in the Kalocsa District Hospital has enabled an average of 129.7 patients per month to receive CT scans on site without travelling. The model used is significant, explaining 86% of the change in the number of patients served (F = 43.535; p < 0.001, adjusted R2 = 0.860). The variable of integration in the model is significant, with an average increase in the number of patients served of 129.7 per month (t = 22.686; p < 0.001) following the introduction of CT due to integration. None of the month variables representing seasonal effects were found to be significant, with no seasonal effect on care. The SWOT analysis has clearly identified the strengths, weaknesses, opportunities and threats related to the integration, the main outcome of which is the acquisition of a CT diagnostic tool. Conclusions: Although we only looked at one segment of the evidence for the effectiveness of hospital integration, integration in the study area has had a positive impact on CT availability, reducing disparities in care.