Operational experience and development opportunities of the unified out-of-hours primary care system in Budapest during its first 21 months

Abstract

Summary

Introduction: The primary care out-of-hours service is a distinctive component of the Hungarian healthcare system, differing from international models in both its organizational structure and operational framework. The introduction of a unified out-of-hours service has created an opportunity for the objective evaluation of its performance.

Objective: To present a descriptive analysis of patient activity and performance data from the first 15 months of the unified primary care out-of-hours service in Budapest.

Methods: The analysis was based on aggregated patient numbers, severity classification, and financing data provided by the Hungarian National Ambulance Service, supplemented by the results of the authors' focus group investigations.

Results: During the first year of operation, nearly 100,000 patients received care through the out-of-hours service in Budapest. In 70% of cases, patients underwent face-to-face medical assessment, while telephone consultation accounted for 14% of all encounters. Overall, 87% of patients presented with low-severity conditions, while only 0.4% were in a potentially life-threatening condition. Mobile response units were dispatched in 15.7% of cases, of which nearly one-third involved post-mortem examinations. Utilization of adult out-of-hours care centres proved to be low, averaging 0.67 patients/hour on weekdays and 1.26 patients/hour on weekends. Annual funding for the nationwide out-of-hours service increased from HUF 12–13 billion under the previous system to more than HUF 35 billion by 2025.

Conclusions: The aggregated data indicate uneven utilization of out-of-hours care capacities and suggest opportunities to improve operational efficiency. The findings support further comparative evaluation of alternative organizational models for primary care out-of-hours services, including pilot assessment of models integrated with emergency care. Closer collaboration between levels of care may contribute to more efficient resource utilization, optimization of patient pathways, and improved quality of care.

Keywords: primary care out-of-hours service; emergency care; health policy; healthcare financing; healthcare service organization