A description of the utilization of long term care and elderly care facilities in Hungary

Abstract

Introduction: Due to demographic changes (the growing rate of elderly population), high patient expectations, increasing care and support needs and growing pressure for accountability, it is necessary to revise the health care system of Hungary. These facts mean general challenges at European level, but up to this point the Hungarian health care system is not ready for handling these changes with adequate solutions. According to the Hungarian Central Statistical Office the proportion of the population over 65 years is 17.2%, but considering the forecast of demographic trends it will increase. In this study we would like to give an overview about Hungarian long-term and elderly care services.Methods: This analysis shows the utilization of National Health Insurance Fund financed chronic and nursery care capacities (except rehabilitation). There are 11 573 long-term care beds in Hungary, which serve the people with chronic conditions and nursing needs. We have compared the utilization and age composition of the acute (performance based financing) and long-term care (financing by per diem) services. Furthermore we have examined the main professional activities which have been provided to over 65 years old patients by hospitals.Results: This study presents that during ten years there has been a significant growth in the proportion of the total hospital days of the population over 65. This proportion was 38% in 2004 and now this is 49%. We found that the proportion of population over 65 is 80% in long-term care departments which are led by physicians, and this number is 89% in the nursing departments. Furthermore, this population occupies 69 % of the hospital days in the departments of general internal medicine (the total number of beds is 3964). The lead diagnoses are chronic kidney failure, congestive heart failure, anemia and noninsulin-dependent diabetes mellitus in the departments of general internal medicine.In Hungary there are merely 150 geriatric beds and the distribution of them from a geographical perspective is unequal. It is an interesting fact that only 89 % of elderly people were served by the geriatric care units, despite the fact that this care is specialized for elderly people and multi-morbid conditions.The utilization of social services is full, the waiting time to get into residential homes is very long. 82% of the elderly people require nursing in residential homes, but at present this is not solved, controlled and financed.Discussion: Based on our results we have found that long-term care types are not sharply separated. It is not clear, what is the difference between the task of internal medicine, geriatric care and long-term care in elderly care. The shortcoming of the health care system is that the legal regulations do not fix the concrete activities; therefore the chronic care capacities frequently serve social and nursing needs. In addition, the home care capacities are not sufficient and there is no connection between social and health care providers.Conclusions: It is worth considering examining where we can connect the two sectors’ services, how we can incite the communication and cooperation, because without task sharing and coordination this services will not be able to satisfy efficiently the needs of elderly population.We have to highlight the possibilities of integrated care at system level and to build a service model especially focusing the people with chronic conditions and long-term nursing needs.