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

Etelka Szivós, Mihály Hegedűs, Sándor Balogh, Fanni Zsarnóczky-Dulházi, Ádám Gyurkó, Lóránt Dénes Dávid

Article ID: 4215
Vol 8, Issue 6, 2024

VIEWS - 553 (Abstract) 495 (PDF)


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.


delivery of health care; efficiency; Europe; health services accessibility; public health systems research; tomography; X-ray computed; health tourism

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Beneda, A., Bíró, M., Burány, B., et al. (2011). State Secretariat for Health: Semmelweis Plan to Save Health Care - A Professional Concept 2011 (Hungarian). Available online: Semmelweis-TervSZKT-20110511_vegleges_közig_egyeztetésre _3_ ( (accessed on 14 January 2024).

Bloom, D. E., & Canning, D. (2000). The Health and Wealth of Nations. Science, 287(5456), 1207-1209.

Boncz, I. (2011). Basic knowledge of health care financing, management and quality assurance (Hungarian). Pécsi Tudományegyetem. Egyetemi tankönyv. Budapest. Medicina.

Boncz, I., Sebestyán, A. (2013). Basics of health insurance and health financing (Hungarian). Pécsi Orvostudományi Egyetem Általános Orvostudományi Kara. pp. 414-415.

Buzug, T. M. (2011). Computed Tomography. In: Kramme R, Hoffmann KP, Pozos RS (editors). Springer Handbook of Medical Technology. Springer Handbooks. Springer.

Byrne, D. (2004). Enabling Good Health For All. A reflection process for a new EU health strategy. Commissioner for Health and Con-sumer Protection. European Communities. pp. 1-11.

Carrin, G., & Hanvoravongchai, P. (2003). Provider payments and patient charges as policy tools for cost-containment: How successful are they in high-income countries? Human Resources for Health, 1(1).

El Archi, Y., Benbba, B., Nizamatdinova, Z., et al. (2023). Systematic Literature Review Analysing Smart Tourism Destinations in Context of Sustainable Development: Current Applications and Future Directions. Sustainability, 15(6), 5086.

Emberi Erőforrások Minisztériuma(EMMI)-Egészségügyért Felelős Államtitkársága (2021). Healthy Hungary 2021-2027 (Hungarian). Budapest, Hungary.

Frenk, J. (2004). Health and the economy: a vital relationship. OECD Observer.

Gulyás, D. (2013). The Hospital Integration Process (Hungarian). Available online: a kórházintegráció folyamata - pdf free download ( (accessed on 14 January 2024).

Hegedűs, M., Pataki, L. (2013). Health care reform and financing issues (Hungarian). Growth and Equilibrium. Gyula Kautz Memorial Conference.

Hegedűs, M. (2013). Methodological issues in the audit of healthcare providers (Hungarian). Számvitel adó könyvvizsgálat: Szakma, 55(2), 83-85.

Hegedűs, M. (2017). The dilemmas of transforming health care (Hungarian). In: Fata I, Kissné Budai R (editors). Oknyomozó tudomány: Tudományos Mozaik. kötet, Budapest, Magyarország: Tomori Pál College. pp. 86-105.

Hegedűs, M. (2019). The economic situation of the health sector and the role of the health-care allowance. Wealth and Society, 12(4), 5-30.

Hegedűs, M (2021a). The Effects of the Covid-19 Pandemic on the Hungarian Health Care (Hungarian). In: Kissné BR, Kromják L, Pál MÉ (editors). Kultúrák találkozása a tudományban - Jövőformáló tudomány: Tanulmánykötet a Magyar Tudomány Ünnepe alkalmából. Budapest, Hungary: Tomori College. pp. 140-151.

Hegedűs, M. (2021b). Bankruptcy model analysis of healthcare providers (Hungarian). Acta Carolus Robertus, 11(1), 13–26.

Josep, F., Martin, M., Suszy, L., et al. (2008). Health systems, health and wealth: assessing the case for investing in health systems: background document 3. World Health Organization. Regional Office for Europe, European Observatory on Health Systems and Policies. pp. 1-80.

Looman, W., Struckmann, V., Köppen, J., et al. (2021). Drivers of successful implementation of integrated care for multi-morbidity: Mechanisms identified in 17 case studies from 8 European countries. Social Science & Medicine, 277, 113728.

Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50(4), 370–396.

Menyhárt, O., Fekete, J., & Győrffy, B. (2018). Demographic shift disproportionately increases cancer burden in an aging nation: current and expected incidence and mortality in Hungary up to 2030. Clinical Epidemiology, 10, 1093-1108.

Mossialos, E., Dixon, A., Figueras, J., Kutzin, J. (2002). Funding health care: options for Europe. World Health Organization. Regional Office for Europe, European Observatory on Health Systems and Policies. pp. 1-16.

Omodan, B. I., & Abejide, S. O. (2022). Reconstructing Abraham Maslow’s hierarchy of needs towards inclusive infrastructure development needs assessment. Journal of Infrastructure, Policy and Development, 6(2), 1483.

Smeets, M., Baldewijns, K., Vaes, B., et al. (2022). Integration of Chronic Care in a Fragmented Healthcare System Comment on “Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study.” International Journal of Health Policy and Management, 12, 7143.

Steele, G. C. (2022). Overcoming political fragmentation: the potential of meso-level mechanisms: Comment on “Integration or fragmentation of health care? Examining policies and politics in a Belgian case study.” Int J Health Policy Manag.

Szigeti, S., Evetovits, T., Kutzin, J., et al. (2019). Tax-funded social health insurance: an analysis of revenue sources, Hungary. Bulletin of the World Health Organization, 97(5), 335-348.

Troisi, R., De Simone, S., Vargas, M., et al. (2022). The other side of the crisis: organizational flexibility in balancing Covid-19 and non-Covid-19 health-care services. BMC Health Services Research, 22(1), 1096.

WHO. (2008). Integrated health services-what and why? WHO Technical Brief.



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