Hungarian Health Care System Research Articles

Current and future burden of obesity at the Hungarian Roma population I

Introduction: The Roma population rapidly gains in importance in the social structure of Hungary. An adverse consequence of the multiple disadvantageous position of this minority is the unhealthy nutrition, which leads to obesity and high prevalence of its co-diseases. Aim: Based on primer anthropometric data collection, we will determine the nutritional status of the Hungarian Roma population, then on the basis of official statistical data, an estimation and prognoses will be prepared on the disease burden of obesity according to genders and age. Method: A long-range forecast of the population size of the Roma minority's prognosis has been prepared on the basis of official statistics and time-series by Spectrum 5.0 demographic software. On this basis, applying the Dynamic Modeling for Health Impact Assessment software, we have prepared a forecast for the incidence and prevalence of the most important diseases attributable to obesity. Results: In the next decades, the number of the Roma population will be doubled, but there is a high level of uncertainty of different forecasts. The nutritional status of the Hungarian roma population is less favorable, than the indicators, characterizing the Hungarian population as a whole. In the next half a century, the prevalence of co-morbidities of obesity will be increasing from 6 thousand up to 26 thousand in the case of women, while in the case of men from nearly 6 thousand up to 17 thousand. Conclusions: The rapidly increasing number of the Roma population is an increasing challenge for the Hungarian healthcare system, which highlights the importance of evidence-based prevention and intervention programs. Orv Hetil. 2019; 160(28): 1097-1104.

PSU30 THE ROLE OF ONE-DAY SURGERY IN WAITING-LIST REDUCTION IN HUNGARY

Nowadays waiting-lists and waiting times are still important issues in most countries. There are many interventions in the Hungarian health care system which have waiting-list obligations and could be performed in one-day surgery form. The aim of the research is to analyze, the role of one-day surgery in the waiting-list reduction process in Hungary. The database of this research was provided by the National Health Insurance Fund of Hungary. It included all of the public financed cases which are related to waiting lists in Hungary (WHO codes, denomination of interventions, reimbursement categories, as well as the type of the health care services) between 2010-2017. The change of case numbers, and the market share of health care services (inpatient/ one-day surgery) related to waiting-lists were also analyzed. Waiting times and waiting cases related to different waiting-lists were not included in this database. 1,719,349 waiting-list cases were performed between 2010-2017. The market share of inpatient cases was significant (71%) in the analyzed period. Inpatient cases in 2017 decreased more than 20% compared to cases from 2010, while one-day surgery cases increased significantly at the same time (297%). Besides most of the performed cases were provided in inpatient form. There were waiting lists which had a constantly increasing utilization of the one-day surgery form. The market share of one-day surgery in cataract waiting-lists was remarkable. In 2010 the market share of one-day surgery was only 34%, however in 2017 it was 90%. Regarding to the transurethral prostate surgery the rate of one-day surgery increased from 29% to 45% between 2010-2017. The utilization of one-day surgery in waiting-list process has been increasing since 2011. According to our results, one-day surgery might play a significant role in cataract waiting-list reduction.

PHP270 - POPULARITY OF NURSING PROFESSION AMONGST STUDENTS WHO ARE BEFORE THE CAREER CHOICE

Human resources is a serious problem in the Hungarian health care system. It would be necessary that the nursing profession to be more popular among youth as well as students to stay in health care who are in health education. Our goal was to assess further plans of students and how their parents' qualifications affect their decision. We would like to assess the motivation of students who are involved in health education and how many of them would work in healthcare later. We surveyed social judgement of nursing profession and the ranking of nursing values based on students' opinions. The study was descriptive, cross-sectional and quantitative. The students before graduation (n=183) and students attending secondary and higher health education (n=71) were studied. The location of examination was all of the school in the city of Szombathely, which are part of nursing education. Survey was conducted between September and October, 2016 using self-constructed questionnaire. Descriptive statistics and Khi-square test were made with Microsoft Excel 2013, results were reported with frequency range of reliability and were considered significant at p<0.05. For high school students stated that impact of parents' educations is prevailed, both the father (p<0.01) and mother (p<0.01) were significant. It is more common to choose nursing profession for students where someone in his acquaintance works as a nurse (p<0.05). According to high school students the nursing headcount is sufficient as opposed to opinions of nursing students (p<0.01). In both groups the responsibility was at the top, high school students think that nurses do not have much responsibility while their views are contrary to this (p=0.0083). The nursing profession is unpopular among Hungarian students, and most of the nursing students are uncertain about staying in health care field. Change of attitude is needed in the society.

The Application of Data Envelopment Analysis in Healthcare Performance Evaluation of Rehabilitation Departments in Hungary

Purpose: Performance evaluation is a general problem both in production and service systems. Generally, operation performance is determined based on input resource utilization and on outputs related data. Performance evaluation is especially complicated when both financial and nonfinancial indicators must be considered in the evaluation of the efficiency of healthcare system. The purpose of this paper is to apply data envelopment analysis (DEA) in order to measure the efficiency of rehabilitation departments curing musculoskeletal diseases.Methodology/Approach: The evaluation of the efficiency of rehabilitation departments includes several parameters. Performance evaluation becomes complicated when several evaluation criteria must be taken into consideration at the same time. In these cases, scoring methods are generally used, which transform performance data into a common scale and an aggregate score is calculated with subjective weights. Using DEA the subjective element of evaluation is eliminated when the weights of inputs and outputs are determined.Findings: The applied DEA model evaluates the performance of rehabilitation departments. The presented analysis highlights the differences between the efficiency of the studied departments, and explores inefficiencies related to economies of scale. The slack values directly show the operational shortcomings in specific areas, and indicate the exact amount of the required changes.Research Limitation/implication: The applied DEA model evaluates the performance of rehabilitation departments. The presented analysis highlights the differences between the efficiency of the studied departments, and explores inefficiencies related to economies of scale. The slack values directly show the operational shortcomings in specific areas, and indicate the exact amount of the required changes.Originality/Value of paper: The originality of the paper lies on the identification of inputs and outputs for the applied DEA model as only nonfinancial indicators were taken into consideration. The analysis involves all rehabilitation departments of the Hungarian healthcare system; consequently, conclusions related to the general state of this area can be drawn.

Patients with dementia and Alzheimer’s in Hungary

Introduction: In this study we would like to give an overview about the presence of patients with dementia in the Hungarian health care system, because besides the cardiovascular diseases these are also important syndromes among the elderly. Alzheimer’s disease is the most common form of dementia and according to the global burden of disease statistics (GBD compare statistics) this (with other dementias) caused 3,8 % of the total deaths and 1,81 % of total DALY’s in Hungary. In the case of the population over 70 years of age it means 5,47 % of the total deaths and 5 % of total DALY’s. Methods: This analysis shows the utilization of National Health Insurance Fund (NHIF) financed active, chronic and nursery care capacities during 2011-15 and the description of social care data from TeIR database during 2011-13. The patients have been selected from the NHIF database on the base of ICD classification (G3, F0-F3). The analysis is particularly focused on the characteristics of the patients over 65 years of age. Results: This study presents that during five years there was a significant growth in the proportion of the total hospital days of the population over 65. The number of patients with dementia diagnosis is stabile; every year 17 thousand people appear in the hospitals. The patient number with dementia is 0,5 % from the total number of patients over 65 years of age and 0,9% from the total hospital days. In view of the age distribution of patients, the 80-84 age group covers the highest percentage (25%), but the proportion of the over 85-89 years of ages is also high (21%). The number of the female patients (12 thousand) is twice as high as male patients (5 thousand). The number of patients with Alzheimer’s disease is continuously growing; it was a 25 percent increasing from 2011 to 2015. The tendency is the same as in dementia; the 80-84 age group covers the highest percentage (27%) and the number of female patients (470) is almost double of the male patients (280). In the public-funded residential/nursing homes there were 10 753 residents (24%) with registered dementia from the total number of residents (45 519) in 2013. Conclusions and discussions: According to the recent European Health Survey the lifestyles of the Hungarian people is not appropriate. The smoking, the heavy drinking or the insufficient degree of physical activity are the most important risk factors of dementia and many other diseases. The prevention and the early diagnosis of dementia are good for the patients and the care system, because the dementia usually means a loss of memory, reasoning, speech, and other cognitive functions, which put a significant burden on the informal carers and caregivers as well. This separated social and health care of people with dementia is not an optimal solution. The residential homes are suffering from the care burden of dementia despite of the increased normative fee of dementia. There are plenty of good practices around the world, which are worth to consider. The preservation of these patients’ dignity and the support in their everyday life should be the key elements of the dementia care, which requires strong cooperation between social and health care. Limitations: The knowledge of the activities of the residential homes is very limited. The TEIR database is not complete and it does not contain some very important information about the cared residents. There is no information about the status of the patients, the care needs, the organized care programs in the social institutes. The main limitation of the examination of dementia is that, there is no methodologically unified collection of the people with dementia. The patients appear in social and health care databases, but some of them do not appear in the statistics. There is no connection between social and health care data, the common information system is missing, because of it is hard to monitoring of the status and needs of the patients. Suggestions for future research: It would be very useful to know the real number of people with dementia, the real burden of dementia and to have information about the satisfaction of dementia care.

Structural Change In The Hungarian Health Care System

Structural Change In The Hungarian Health Care System

PHP4 - The Analysis of the Number of Same-Day Surgery Cases in 2015 in Hungarian Hospitals

Over the past few years one day surgery has become more specific in health care systems throughout the world. This study analyzed the available same-day surgical procedures in the Hungarian health care system in the year 2015. Data were derived from the financial database of National Institute of Health Insurance Fund Administration and covering the year of 2015. We applied the usual performance indicators by comparing the actual number of same-day surgical interventions to the theoretical number of same-day surgical intervention which could have been performed by the hospitals among ideal circumstances. The number of cases was used to establish the rate of same-day surgical procedures. Hungarian hospitals were classified into the following groups: university clinical centers, county hospitals, city hospitals, specialized hospitals, Budapest’s hospitals, children’s hospitals and national health care institutes. 62.29% of the achievable same-day surgeries was accounted for by the publicly funded institutes in Hungary in 2015. We found that the rate of the above interventions was the highest in specialized hospitals (98.82%). The rate of the achievable same-day surgery’s case number was 60.03% in university clinical centers, which is lower than that in county hospitals (61.38%) and the city hospitals (66.90%), on the other hand, it is higher than the rate of Budapest’s hospitals (55.49%), children’s hospitals (50.66%), and national health care institutes (28.23%). Our results showed that in 2015 the specialized hospitals performed the most, while the national health care institutes performed the least case numbers regarding same-day surgeries in Hungary.

Model concept of the health economic evaluation of low-dose CT lung cancer screening in Hungary

Lung cancer is a rapidly progressing, often life-threatening disease that constitutes a huge societal burden. Because of the scarce resources of the Hungarian health care system, the cost-effectiveness of introducing low-dose computed tomography screening is a relevant health policy matter. The aim of this study is to design a model concept for assessing the cost-effectiveness of low-dose computed tomography lung cancer screening in Hungary, and to define the required steps for performing the analysis. A targeted literature review was conducted to identify and synthesize the evidence on efficacy and effectiveness of screening, and results were evaluated based on adaptability to Hungarian settings. We also summarized the available Hungarian scientific evidence and reconstructed the potential patient pathways. In accordance with these findings, we recommend to perform the full health-economic evaluation of low-dose computed tomography lung cancer screening using a complex model structure that consists of several sub-models and is capable to follow the population at risk on life-time horizon. The proposed cost-effectiveness model will be suitable to provide data for further analyses that support decision-making on introducing low-dose computed tomography lung cancer screening as public health program. Orv Hetil. 2017; 158(25): 963-975.

Violence against health care providers and its correlations with sociodemographic and workplace-related factors

Violence against health care providers is getting more awareness nowadays. This topic is in the focus of international scientific attention also, although in Hungary exact data is lacking. The present study aimed to assess the correlations between violent acts against health care workers and their effects with different sociodemographic and workplace-related factors. A quantitative cross-sectional online survey was conducted enrolling 1201 health care providers. Data were analysed trough chi-square, Kolmogorov-Smirnov, Mann-Whitney and Kruskal-Wallis tests, where appropriate. Verbal and physical aggression was experienced more frequently by nurses who were males, above the age of fifty, working in in-patient care or in 12 hours shifts or constant night shifts. The same groups of health care providers suffered more from the negative emotional consequences of violent acts. Aggression is a serious problem in the Hungarian health care system, therefore employees have to be prepared for these acts. Orv. Hetil., 2017, 158(6), 229-237.

Recent changes in the Hungarian healthcare system, 2010–2017

The paper provides a narrative and an assessment of the most important changes in the Hungarian healthcare during the 2nd and 3rd Orban governments. The most important aspect is to understand that during this period the healthcare sector was not a priority, but nevertheless fundamental changes occurred. The explanation is that the Prime Minister, Viktor Orban, completely restructured the entire constitutional arrangements and the changes affected the healthcare sector. The two main strategies were renationalisation and centralisation. The relative independence of the healthcare sector, which was the result of the reforms occurring between 1992 and 2010, was almost fully reversed and the Ministry of Health ceased to exist in 2010.

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

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.

Experiences and Conclusions of the Hungarian Emergency Sepsis Register

Objective: Early recognition is a key step in decreasing morbidity and mortality in sepsis. Like in other European countries an ever growing number of septic patients enter hospitals via emergency departments. Our goal was to assess the number and severity of patients with sepsis, severe sepsis and septic shock attending the Hungarian emergency departments. Methods: Two-hundred and ninety-nine patients were entered into the Hungarian Emergency Sepsis Register, focusing on age, disease severity, monitoring and oxygenation. Application and time of administration of antibiotics, use of biomarkers, i.e. lactate and procalcitonin, disposition of patients were assessed using a web-based electronic questionnaire. Results: Data arriving from twenty emergency departments revealed that with severity of the disease oxygen administration and level of monitoring increased, along with antibiotic administration and use of biomarkers. Time spent in the ED did not differ between septic, severely septic and septic shock patients; however higher level of care was provided for the sickest patients. Conclusion: Our register data indicate that sepsis presents a substantial challenge to Hungarian emergency departments. The set standards for timely, adequate treatment are not yet met. The results are however also influenced by charactersitics of the Hungarian health care system, most notably the lack of hospice systems. Further studies are needed to separate the subset of patients who would require and of life care.

New hospital structure in the twenty-first century: the position of level III (tertiary) neurological and stroke care in a changing healthcare system.

AimThe determination of the necessary capacity and number of neurology wards of level III progressivity that can be defined in the system of criteria detailed in this article and which possess optimal operating conditions in Hungarian terms.MethodsWe used the National Health Insurance Company’s database to calculate case numbers and capacity for different levels of neurological and stroke care. We also revised the allocation of advanced diagnostic and therapeutic technologies, and proposed changes, based on health insurance data. We also discussed these propositions with clinical experts to test their viability.ResultsWe determined the adequate number of organisational units capable of providing special neurological healthcare services on the basis of the basic data of the Hungarian healthcare system, specifying this number as 6 instead of the current 11.ConclusionsIn our study, we have identified significant bias in the nationwide level of neurological and stroke care organisation, which needs revised allocation of healthcare resources. Naturally, this can only be carried out through the restructuring of the emergency care system and the expansion of pre-hospital care.

Spatial characteristics of access of third-country citizens to the Hungarian public health care system

Spatial characteristics of access of third-country citizens to the Hungarian public health care system

Work schedules in the Hungarian health care system and the sleep quality of nurses

One way of ensuring the continuity of health care is the shift work, which is burdensome and it can lead to sleep disturbances. The aim of the study was to measure the typical Hungarian nursing shift systems in hospitals, to analyse the causes of irregular work schedules, and to compare the sleep quality of nurses in different work schedules. 236 head nurses filled out the national online survey, and 217 nurses in clinics of the University of Pécs filled the Hungarian version of Bergen Shift Work Sleep Questionnaire. The head nurses provided data of 8697 nurses's schedules. 51.89% of nurses work in flexible shift system. 1944 employees work in regular shift system, most of them in the following order: 12-hour day shift and 12-hour night shift, followed by a one- or two-day rest. Where there is no system of shifts, the most frequent causes are the needs of nurses and the nurse shortage. Nurses who are working in irregular shift system had worse sleep quality than nurses who are working in flexible and regular shift system (p = 0.044). It would be helpful if the least burdensome shift system could be established.

Motivations for foreign employment and carrier change among Hungarian physiotherapists

An increasing motivation can be experienced among professional workers within the Hungarian healthcare system towards foreign employment or career change. The aim of the authors was to assess Hungarian physiotherapists' migration and career changing behaviour and to understand the underlying factors. A national survey in Hungary from April to August, 2014 was performed. Only physiotherapists who practice in Hungary were included (n = 215). The results suggest that age (p<0.05) and the rate of financial appreciation experienced in the workplace (p<0.01) significantly affect the appearance of migratory thoughts. Those physiotherapists who do not feel themselves financially appreciated, are 55 times more likely to search for employment outside the country's borders [OR = 55.28 CI (95%) = 18.85 to 161.12]. The most common causes for that are unfavourable financial (p<0.01) and moral recognition (p<0.01). In order to prevent our already highly-qualified colleagues from leaving the country or from considering to leave the profession we should concentrate on increasing the financial and moral appreciation of the profession within the Hungarian healthcare system.

Asylum-seekers' mental and physical health problems: practices and recommendations

The Hungarian health care system faces new challenges with the unprecedented increased rate of migration. Asylum-seekers arriving are a heterogeneous group. Their health care needs vary depending on their country of origin and the quality of the health care they received prior to arrival, not to mention the impact of the migration process on their health. Described within this paper are the challenges an asylum seeker might face in obtaining care on arrival into the host country and the challenges clinicians face in providing that care. This review is designed to give health professionals the necessary knowledge to care for asylum-seekers in a culturally aware and clinically informed manner.

Management of multiple myeloma in Hungary in 2016

The last decade has witnessed a dramatic progress in the treatment of multiple myeloma. Both the chemotherapy protocols and the supportive therapy options have improved significantly since the publication of the previous Hungarian national guideline. An increasing proportion of patients now reach a durable response and cure became a potential option for some. The aim of the authors was to adapt the international guidelines to the specific circumstances of the Hungarian healthcare system in the light of the most recent developments.

The characteristics of diagnosis, patient care and education of asthma and COPD patients from the perspective of the actors in the Hungarian healthcare system

In our study, we wanted to assess the workload under which health professionals work with asthmatic and COPD patients, the average time spent on investigation, patient care, patient education and on checking their previously acquired knowledge. We also wanted to know who educates these patients to the proper use of inhalation devices and how often they check their usage. We have conducted personal interviews and online surveys among health professionals. We made distinguished time spent on “freshly” diagnosed patients, routine control examinations and previously diagnosed patients. Participants: asthma nurses from the pulmonary care network, hospital departments, specialized practices and pulmonary care units; pulmonologists; specialists from internal medicine departments and emergency health care centres and GPs (general practitioners). Our results show that in every group of healthcare professionals involved in the treatment of these patients, the number of daily meetings between healthcare professionals and patients is remarkably high (an average of 30 patients a day), and there is not enough time for patient education. Checking the proper usage of the device is often skipped and no appropriate educational materials are available. Patients are not likely to have sufficient knowledge of their disease or the appropriate usage of their inhalation devices. Reorganization of the Hungarian COPD and asthmatic patient care system is needed as soon as possible to provide effective patient education and patient care.

The Hungarian Care Managing Organization Pilot Program

ObjectivesThe aim of this article was to provide a description of the Hungarian care managing organization (CMO) pilot program and its environment, incentive structure, and preliminary outcomes. The need to change the behavior of doctors to increase the effectiveness and cost-effectiveness of the system was the key rationale for the Hungarian CMO pilot program. MethodsAfter an application process, nine CMOs were entitled to enter into the system in July 1999. By 2006, there were 14 CMOs covering 2.1 million people. The Hungarian CMO program tried to combine the advantages of both the US managed care programs and the UK general practitioner fundholding system, within the constraints and opportunities of a Central-European country committed to a single-payer health insurance system. ResultsThe revenue of CMOs derived from a risk-adjusted capitation. The capitation formula was weighted only by age and sex. The expenditures of the CMOs included all the health expenditures on their patients that occurred in any part of the health care system. The average savings rate for all CMOs for the fiscal years 1999 to 2007 was 4.94%. The highest rates of savings were realized in chronic and acute inpatient care and medical devices. The pilot was discontinued in 2008 without a comprehensive evaluation of the experience. ConclusionsWe can conclude that this pilot had a significant contribution to the modernization of the Hungarian health care system.