Hungarian Health Care System Research Articles

Experiences of reliability tests in Hungarian healthcare system

Reliability tests or integrity tests involving doctors play an important role in the healthcare sector in order to ensure patient safety and maintain professional standards. This paper provides an overview of the importance and process of physician trustworthiness testing and the impact of testing results on health services and patient trust. The study analyzes the aims, methods and results of the studies, highlighting the positive and negative experiences. The research also points out that the regularity and comprehensiveness of reliability tests is vital in monitoring the performance of doctors and maintaining professional standards. Finally, the study makes recommendations for the further development and efficiency of the tests in order to improve the health care system.

Improving Mental Health of Medical Students through Movement, Art, and Interpersonal Relations

IntroductionBurnout, and symptoms of distress amongst medical students is becoming increasingly common due to the uncertainty of the Hungarian healthcare system. Change itself may be the cause of stress. Since the pandemic, the workload has been growing among health care workers. Anxiety is increasing even for beginner practitioners.ObjectivesOur examination intends to improve the mental health of the students with a variety of methods to help them develop resilience towards everyday stress, such as: 1.increasing body awareness2.exploring the inner drivers of vocations by self-esteem, worth symbols and emblems3.supporting relationships and interpersonalityMethods We had advertised a monthly course in the mailing system of the students of the Semmelweis University (Neptun). Each occasion would go as far as 240 minutes in length. Selection criteria were: guaranteeing participation in the sessions. Any applicant suffering from mental health problems requiring medical attention, or the applicant regularly skipping occasions of the session would lead to his or her getting dismissed. Courses consists of musical aerob movement and receptive art therapy tools (exl. „Self-exhibition”). The aim was to interpret ones identity via images individually. In advance of the first occasion, the applicants were interviewed to talk about themselves their career, mental health and issues, why they want to participate in the sessions. The closing interviews are still in progress. The examination was permitted by the SE-RKEB.Method of examinationQualitative: personal interviews, exploring talks about the artworks (“Self-Exhibition” collage), made during the course.Results 20 individuals started the course and 10 of them finished. The Body and Mind movements (Body Art - fusion of functional and breathing exercises, yoga and therapeutic exercises) has proven to have great importance throughout the session. The prescribed length of it in time was the third of each occasion. The joint analysation and interpretation of various artworks, images, visual narratives, even, the discussion of experiences in form of structured group activities has noticeably helped the interpersonality and social connections being formed for each individual who participated. The homeworks (eg.: Self Exhibition-collage, own worth emblem-collage etc.) and the active conduction of a diary has helped both to achieve results and have more involvement in the group.Image:Image 2:ConclusionsClosing interviews are still in progress.Disclosure of InterestNone Declared

Working 40 years as medical doctors.

The health status of health professionals, including medical doctors is an important topic, although it is an under-researched area in Hungary and in the East-Central European countries as well. Our quasi-cohort research was focused on the health status, morbidities, anthropometric parameters, lifestyle and professional career of Hungarian medical doctors who graduated in 1979, following them 25y, 30y and 40y after graduation, seeking differences between professional groups and genders. In 2019, the mean age of participants was 64.9y, the average number of children was 2.08, higher among surgical professionals (2.43). Men reported higher number of own children. The number of night shifts decreased during the past decades. Most of them is already retired, 70% is working besides receiving a pension. 27% changed their medical specialty, 36% intended to work in another field of medicine, when graduated. About 10% of them achieved scientific (PhD) degree, most of them were satisfied with own professional carrier. The body weight and BMI significantly increased during decades, without statistical difference between genders and professional groups. Diabetes was self reported in 7%, hypertension in 44%. Men neglected more frequently their regular health check-up. Compared to their patients at the same age, 71% rated their own health status better. Among those, who reported regular physical activities, the ratio of men was higher; the average time spent on sport was the same as in the past decades, although the ratio of persons who had regular physical activity decreased, fewer participated in team sport activities. Their sleeping habit is quiet, the time is 6.3 h between workdays and 7.7 h on weekends. Burn-out was not reported. The ratio of smokers decreased; the self-reported daily intake of alcoholic beverages was 1.3, the weekly 3.7 units. Differences described earlier between professional groups disappeared. The problems of the recent Hungarian health care system were similarly rated, although the income of Hungarian physicians has increased to a great extent in the past years. Orv Hetil. 2023; 164(29): 1127-1133.

Translations for patient safety communication

Clear communication is essential to ensure patient safety and quality care, and written communication and translated documents play a crucial role in their provision. Therefore, it is critical to create a list of vital documents and to ensure that they are language accessible for patients who do not speak the local language. The purpose of this study is to identify documents created within the Hungarian health sector, which contain health or legal information that may have important implications for patients’ health, and are also essential for the provision of safe and high-quality health care, and which would also need to be made accessible to foreign patients. The study involved seven health professionals and a medical lawyer. Data was collected using qualitative methods, including semi-structured interviews and an online questionnaire. The data obtained was subjected to basic thematic and frequency analysis. The results show that health professionals consider six documents to be vital for Hungarian health care. In addition to this, a few other non-treatment related documents were identified, whose translation would greatly contribute to effective communication with foreign patients. This study provides a solid basis for the creation of an official list of vital documents for the Hungarian healthcare system and can serve as a guide for other linguistic environments as well.

What do patients think about the Hungarian health care system and medical students’ learning outcomes? A cross-sectional study on the patients’ perspective in Hungary

BackgroundThe doctor-patient relationship has changed a lot in the 21st century and the varying expectations of the patients play an important role in future professional medical care. The knowledge of patients’ needs is crucial in determining the learning outcomes in medical education. The objective of this study was to examine the expectations of the patients regarding professional and soft skills (e.g. communicational skills, empathy) of doctors and to get a deeper view.MethodsFace-to face data collection through self-reported questionnaire in accredited health care institutions (GPs, hospitals, outpatient care) in Hungary was carried out in 2019. Descriptive statistics, independent sample t-tests, k-means cluster and gap matrices were performed to analyze the data.ResultsIn total 1115 patients (male-female: 50–50%, age groups: between 18 and 30: 20%, between 31 and 60: 40% above 60: 40%) participated in the survey. They rated sixteen learning outcomes along with two dimensions: importance and satisfaction. Except for one learning outcome, patients rated the outcomes more important than they were satisfied with them (negative gap). Positive gap was registered only in the case of respecting individual specialty during patient care.ConclusionsThe results suggest the importance of learning outcomes in relation to the rate of satisfaction from the patients’ perspectives. In addition, the results support that patients’ need are not met in medical care. Patients’ ratings also make an emphasis on the fact that besides professional knowledge other learning outcomes are also important in health care which should have been emphasized as a basis in medical education.

The Evolution of the Normative Regulation in Hospital Safety and Security

Despite the Covid-19 epidemic, relatively little is said about hospital safety and security these days, in fact, the concept, along with its complexity, is not precisely defined. In 2016,the concept of critical infrastructures and thus the operator’s security approach appeared in the Hungarian health care system. This required a more complex approach than before on the part of the security organisations. It is absolutely necessary to manage the human resources organisation, the operation of the facilities, the various service areas and the so-called classical security and safety areas such as property, fire, environment, disaster management and labour safety areas of the institutions in one management system. These are the areas where complex interpretation can be encountered in every case during Operator Security Planning. In my study, I review the evolution of the normative regulation of these areas and their impact on the security operators’ activities in hospitals from the period of the regime change to the present day, until the emergence of the complex operator security approach.

Goals and methods of managed entry agreements – can we get what we want?

ObjectiveWe aimed to examine managed entry agreement (MEA) methods and their relation to nationwide drug reimbursement policy goals in the context of the Hungarian health care system. MethodFirst, a targeted literature review was performed that identified the most relevant MEA methods and drug reimbursement goals. Then, by using the findings of the review, a survey was developed: the first part of the survey aimed to ensure that interviewees have similar understanding of different types of MEAs and related policy goals; in the second part the interviewees were asked to prioritize drug reimbursement goals and indicate their perception about the impact of MEA techniques on the reimbursement policy goals. ResultsThree groups of MEA techniques were identified: cap type, clawback type and rebates or free treatment doses. Six policy goals were identified: cost containment, reduction of uncertainty of effectiveness, sustainable finance, patient access improvement, cost-effectiveness improvement, handling administrative burden. None of the MEA techniques showed clear advantage over all others. Cost containment, improvement of patient access and reduction of uncertainty around effectiveness were ranked as most important drug reimbursement goals. Cap type agreements were deemed to uniformly support the policy goals of cost containment and sustainable financing. Clawback type agreements strongly support cost containment policies. Rebates and free treatment dose(s) methods had positive impact on four policy goals. ConclusionThe implementation of managed entry agreements shall be considered and motivated by pre-defined drug reimbursement policy goals. During the application of MEAs, setting priorities and making trade-offs between different policy goals are inevitable.

MIGRATION OF MEDICAL PROFESSIONALS IN HUNGARIAN HEALTHCARE SECTOR – LITERATURE REVIEW

Medical migration is a global phenomenon, an important challenge of globalization and the current global economic trend, which plays a critical role in the operation and maintenance of healthcare systems. This applies to Hungary as well, the migration of health professionals has been a problem that has seriously threatened the Hungarian healthcare system for at least 20 years. In my research, I conducted an integrative literature review of 8 scientific articles about the migration of Hungarian healthcare professionals published in the last 5 years (2018-2022), which I found in the PubMed and ScienceDirect publication databases. The aim of my review study is to provide a complete and satisfactory summary of the literature examining and analyzing the current migration trend in Hungarian healthcare, as this way, even with the lack of the official statistical data, we can gain insight into the current situation. Examining the profile of migration, it can be seen that the situation is most critical in the professions of internal medicine, family medicine, and infant and pediatric medicine in terms of medical specialization, while and in terms of country provision and demographics, there is the most prominent shortage of specialists in Békés, Nógrád, Jász-Nagykun-Szolnok, Tolna and Szabolcs-Szatmár-Bereg counties compared to other counties. The labor crisis in Hungarian primary healthcare is gradually escalating and also within ten years, Hungary will face a severe shortage of pediatricians. Optimizing the working conditions of healthcare workers is a political and social interest, which would probably take a long time, but could ensure high-quality care in the long run. One of the most important conclusions of the review is that Hungarian healthcare workers abroad left primarily because of better quality of life and more favorable financial conditions, but some of the research results showed, that changes in these conditions at home would encourage them to return home.

Burnout syndrome among health care workers in Hungary – a literature review

Burnout is recognised as an occupational hazard and prolonged response to chronic interpersonal stressors at work in various people-centred professions, with higher prevalence among health care workers. The main objective of this research was the integrative review of the literature on burnout syndrome in Hungarian health care workers. Twelve (12) studies found in PubMed database were included in the research and a number of important conclusions have been summarized about burnout syndrome among employees of the Hungarian health care system. Also, as important conclusion it has been highlighted, that recognising, preventing, and treating burnout and depression among health care workers should be one of the priorities of the health care in Hungary.

The role of the school health care system in the prevention of childhood obesity - lessons of a pilot study

Childhood obesity is a growing problem with public health significance, so effective prevention is in our public inter-est. Specialists in the school health care system are of paramount importance in the prevention of childhood obesity. In the present study, the institutional framework of the Hungarian school health care system, the scope of tasks and competencies of the professionals, and the recommendations of the World Health Organization in relation to the prevention of obesity are reviewed. On the other hand, we interviewed three school doctors and a school nurse. The interviews showed that although their workload is high and their capacity is finite, in addition to their fixed tasks (such as regular physical examinations and screening of overweight students, grouping of physical education classes, public health tasks), these professionals implement sensitive care for overweight students, support for weight control, often in collaboration with school management. With their creative solutions, exemplary behavior and forward -looking proposals, they highlight the intervention points for optimizing the operation of the school health care sys-tem, with an emphasis on the role of health policy makers.

Changes in the practice of electroconvulsive therapy at Semmelweis University before and during the COVID-19 pandemic

IntroductionThe Department of Psychiatry at Semmelweis University is the largest electroconvulsive therapy (ECT) centre in Hungary, where a total number of around 300 treatments are conducted every year. Certain changes were administered in 2018 and 2019 in our logistics and internal protocols that helped to increase the number of treated patients and improve quality of care. The COVID-19 pandemic caused serious disruptions in the Hungarian mental health care system , therefore there was a realistic fear that many patients who required ECT would not receive this form of tretament.ObjectivesOur goal was to assess the effects of the pandemic on our ECT service, and to analyse whether patients were able to receive treatment, despite the logistical difficulties.MethodsWe retrospectively gathered data from our internal documentation to compare the number of ECT treatments with the previous years. We also had to take into account the fluctuation in our general caseload of psychiatric patients, since our Department acted as a COVID-19 treatment centre for several months.ResultsTotal number of ECT treatments decreased in 2020 after a peak in 2019, however the numbers were not much lower compared to the years before changes in 2018. Unfortunately, we see a more direct effect of the 3rd wave of the pandemic.ConclusionsWe can conlude that there is a decrease in the number of ECT treatments due to the pandemic, however, the fact that we still provided service in most parts of 2020 and 2021 for patients with the most severe conditions is a serious achivement.DisclosureNo significant relationships.

Roadmap for large-scale implementation of point-of-care testing in primary care in Central and Eastern European countries: the Hungarian experience.

The aim of this study is to give a broad overview of the international best practices regarding the implementation of point-of-care testing (POCT) in primary care (PC) setting and to highlight the facilitators and barriers for widespread national uptake. The study focuses on the managerial and organizational side of POCT, offering a roadmap for implementation as well as highlighting the most important requirements needed to unlock the clinical and economical potential of POCT in the Hungarian healthcare system. We conducted an English language scoping literature review between January 2012 and June 2021 to assess the recent trends of POCT implementation in developed countries. Our research focuses on the recent publications of several European and Anglo-Saxon countries where POCT utilization is common. In parallel, we reviewed the Hungarian regulatory framework, ongoing governmental legislation, and strategies influencing the POCT dissemination in the Hungarian PC sector. Among the possible POCT usage in PC, we identified several clinically relevant devices and tests (C-reactive protein, urine, blood glucose, D-dimer, prothrombin time) important in screening and early detection of morbidities representing high disease burden. Based on international literature, general practitioners (GPs) are interested in the shortened diagnostic times, portable devices, and better doctor-patient relations made possible by POCT. There are several concerns, however, regarding initial and operational costs and reimbursement, limited scientific evidence about quality and safety, unclear regulations on quality validation of tests, as well as managerial aspects like PC staff training and IT integration at the GP level. As our review highlights, there is considerable interest among GPs to implement POCT as it has the potential to improve quality of care; however, there are many obstacles to overcome before widespread uptake. Further investigation is recommended to elaborate management and quality insurance background and to develop appropriate regulatory framework and financial scheme for GP practices. Preferably this work should involve the local practicing GPs to better tailor the implementation roadmap to country-specific details.

065 Application of teledermatology during the first wave of the COVID-19 pandemic in Hungary

During the first wave of the COVID-19 pandemic, outpatient care was limited and it resulted in developing an asynchronous teledermatology system. The aim of our retrospective study was to provide quantitative data the first time about use of teledermatology in the Hungarian healthcare system between March 25 and July 13, 2020. The number of cases, regional distribution and type of diagnoses were analyzed. We also followed up patients who were referred to in-person dermoscopic examination. A total of 10.287 teledermatology consultations were completed at our department.

Exploring Effectiveness Reserves in Hospitals with the DEA Method

In our study, we undertake a relative efficiency analysis of hospitals providing inpatient care, which play a key role in the Hungarian health care system. According to the Competitiveness Report 2020 of the Hungarian National Bank, the Hungarian health care system has a number of reserves, and the sustainability of the system can be improved by using these reserves. In the 2015-2019 period, particular attention has been paid to the identification of achievable and meaningful indicators in the sector under review. The relative effectiveness analysis (DEA) method can be used to address this challenge. The units of our analysis are state-owned institutions in Hungary, typologised by the total number of beds. General profile hospitals with a bed count between 600 and 1200 beds were included in the analysis. The results of running the programme have clearly shown that there are some institutions that do not operate as efficiently as the majority of the organisations included in the study, but further research and refinement of the indicators is needed to determine the practical application of the pilot studies.

Implicit bias against the Romas in Hungarian healthcare: taboos or unrevealed areas for health promotion?

The Roma or Gipsy population is the largest ethnic minority both in Europe and Hungary with a 10-15 years lower life expectancy and significantly worse health indicators than majority populations. The purpose of this exploratory study was to investigate a sensitive and controversial topic: the perspectives of healthcare staff about the presence and impacts of implicit bias in the Hungarian healthcare system towards Roma patients. Therefore, between June 2017 and May 2018 semi-structured interviews were conducted involving 13 healthcare professionals. Interview transcripts were coded and thematically analysed. The presence and occasional manifestation of prejudices against the Romas were noted by the interviewees, most commonly in the form of longer waiting time, comments or other meta-communicative tools. Study participants appeared to exclude a direct relationship between health providers' implicit bias and the lower quality of health services or the worse health status of Roma patients. However, as reported, indirect negative effects may occur in cases where a patient refrains from seeking care due to previous perceived or experienced discrimination. As barriers to effective patient-provider communication and cooperation, differences in culture, health-seeking behaviour and gaps between health literacy levels were emphasized. In terms of prevention, enhancing anti-discriminatory attitudes from early childhood within the families, the role of media in conveying unbiased information, increasing health awareness of the Roma people as well as educating healthcare providers on culture-related issues may be beneficial. Stress and burnout of healthcare professionals also need to be addressed as these may impact on the enactment of unconscious biases.

The place of tactical medicine in the Hungarian Health System

The global security environment of our world is constantly changing, which put pressure on our social systems for constant adaptation and respond. The emergence of postmodern terrorism is such a prominent feature at the turn of the century. The real threat of terrorist acts has brought a new social expectation, which is the need of health care for citizens injured in terrorist attacks. Law enforcement and the health sector cannot respond to this challenge alone, only together are they able to fulfill this requirement. The result of their cooperation is the birth of a new frontier profession, the tactical medicine. Being a young profession, the content behind this technical term is not widely known. In my article I try to introduce and place tactical medicine in the Hungarian health care system.

Prejudices and their healthcare implications. Lessons learnt from a national survey.

Introduction: The presence and recognition of prejudice during care were examined among healthcare professionals towards the Roma population, the largest ethnic minority in Hungary. Aim: The aim of this study was to explore the extent to which prejudice in the Hungarian healthcare system might affect the quality of care and, thereby, the health of the Roma patients. Method: Semi-structured interviews were conducted between June 2017 and May 2018 with 13 interviewees. Qualitative methods were applied to analyse the transcripts. Results: Our respondents generally confirmed the presence of prejudices in the healthcare system. Prejudicial attitudes and discriminatory behaviour are less common in wards where the prevalence of disadvantaged patients (HIV-positive, homeless) is high (e.g., infectology). Prejudice is not specifically directed at the Roma ethnic minority, but also extends to populations living under poor socio-economic conditions, or with underlying self-destructive behaviour (alcoholism, drug use). In the opinion of our interviewees, occasional prejudicial behaviour does not lead to sub-standard care, but, on the contrary, to positive discrimination. Prejudice does not directly lead to poorer health, but it cannot be ruled out that it may indirectly contribute to it, in the case if the patient does not seek medical attention due to a former negative experience within healthcare. Conclusion: Our results confirmed the occasional presence of prejudice against the Romas in the healthcare system, however, this may not directly contribute to Romas' poorer health status. Our results also highlighted the importance of prevention, including the education of both parties and the prevention of the burnout of care providers. Orv Hetil. 2020; 161(19): 789-796.

The Capacities of Primary Health Care in Hungary: A Problem Statement.

In the establishment, development, and provision of equal access to the health care system, the operation of adequate primary health care is essential and has undergone significant transformation in the most developed countries over the past decades. The central and eastern European countries, including Hungary, are struggling with the disadvantages of the traditional model of primary health care, based on independent general practitioner and family paediatrician practices: the ability of the system is extremely limited to meet emerging needs and is facing a chronic human resource crisis. In the current study, the functions, legislation, and challenges of the Hungarian primary health care system, as well as the basic interrelations of the development of vacant general practitioner and family paediatrician districts were examined, and the government measures for the sake of solving the occurrence of the vacancy and improving access in the lagging areas. (The situation of the other fields of primary health care—e.g., dental care, child care officer care, etc.—was not subject of the analysis.). The basic characteristics of the vacant districts (type by supplied age group, bounding region, population size, length of vacancy) were primarily examined by the analysis of categorical and metric variables, with the use of cross-tabulation and nonparametric correlation, while the discovery of soft interrelations was supported by an expert interview conducted with the professionals of the Primary Health Care Department of the National Health Care Services Centre. In Hungary, the fundamentals of primary health care are made up of the individual practices of general practitioners and paediatricians, and there is a growing concern about the permanent vacancy of the districts, and the fact that the system is less suitable for meeting the needs of the population. The ever-increasing number of vacant general practitioner and family paediatrician districts due to the growing shortage of professionals because of aging and emigration poses the burden of substitution on the physicians in existing practices, that concerns the access of more than a half million people to health care, almost 70 percent of which live in settlements with a population less than 5000 inhabitants.

PNS290 EVIDENCE-BASED VALUE FRAMEWORK FOR THE EVALUATION OF CLINICAL PHARMACY SERVICES

To identify and evaluate potential outcome measures for the assessment of clinical pharmacy services (CPSs) in order to facilitate the implementation and monitoring of CPSs within the Hungarian healthcare system. A literature review on PubMed was conducted to identify original controlled studies assessing the effects of CPSs. Studies eligible for full-text data extraction were selected by title and abstract screening. Outcome measures were aggregated in four categories: clinical, patient-related, cost-related or health care professional-related outcomes. They were further analysed according to 1) sensitivity to capture benefits of CPSs, 2) generalisability and transferability, 3) measurability including the availability of standard measurement methods. In total, 46 publications with 73 CPSs interventions were included in the analysis. A large number (83) of outcome measures had been used to evaluate the effect of the interventions. The most prevalent measures included medication appropriateness (n=17) and readmission rates (n=12). Significant positive effects were most frequently related to outcomes sensitive to pharmacotherapy management. Very few studies could prove the benefit of CPSs in hard clinical endpoints partly due to short study duration and limited statistical power. List of recommended outcome measures for evaluation of CPSs were created based on feasibility of measuring potential outcomes. Evidence generated from low quality studies may lead to false expectations concerning the added value of CPSs in healthcare. More methodological research is needed to address the limitations of existing research methods to get more realistic evidence on the contribution of CPSs to health care. The proposed value framework may support implementation and improvement of CPSs. The short-listed outcome measures are recommended for inclusion to local studies for the evaluation of CPSs. Standardization of CPS interventions, appropriate study design, long study duration and sufficient sample size are also suggested in order to improve the validity and generalizability of conclusions.

Structural Changes in the Hungarian Healthcare System Between 2000 and 2017

BackgroundThe rigid and old-fashioned structure of the Hungarian healthcare system has been discussed since the mid-1990s and is at the center of professional and policy debates. It is characterized by the too high number of acute care hospital beds in international comparison; access is regionally unequal; levels of progressive care are mixed; and there is a nonuniform emergency service system with unequal access to the emergency room, heterogeneous quality of care, and unexploited opportunities of modern health technology (eg, 1-day surgery, minimally invasive procedures, telemedicine). ObjectivesThe aim of this study is to analyze the indicators of ongoing structural changes of the Hungarian healthcare system between 2000 and 2017. MethodsData are derived from the Organisation for Economic Co-operation and Development Heath Statistics, Hungarian National Statistical Office, National Health Insurance Fund Administration and the database of the European Structural Funds. The methods used for the analysis are descriptive statistics, trend analysis, and longitudinal data. ResultsThe total number of hospitals beds showed a 32% reduction between 2005 and 2017. Parallel with this subsequent reduction of hospital bed capacities, we can see a moderate reduction (22.3%) in the number of discharged patients from hospitals: from 2005 to 2017, 2.55 million to 1.95 million. The average length of stay in acute hospital care has decreased from 6.3 to 5.1 days. About 25 to 27 small local hospitals lost their acute or short-term care profile (mainly intensive care units, internal medicine, surgery, and pediatric care wards) and became long-term care, chronic care, or rehabilitation profile hospitals. ConclusionStructural change is in progress in the Hungarian healthcare system, and some efficiency gains have been reached. Nevertheless, still there are significant potential efficiency gains in the better organization and management of health services in addition to the dissemination and better incorporation of modern healthcare technologies.