Hungarian Health Care System Research Articles

Implementing Risk Adjusted Capitation Payments with Health Care Reforms in Hung

Since the late nineties Hungarian governments have been considering the introduction of new health care arrangements by establishing organizations with devolved responsibilities for the management of health care. These organizations are typically financed through a weighted (risk adjusted) capitation system which is regarded as an adequate and optimal tool for resource allocation purposes. Through capitation one needs to handle large inequities in the Hungarian health care system and keep an eye on the incentives for efficiency. For the capitation formula a relatively broad choice of risk adjusters are available in the form of pharmacy- and diagnosis-based patient level utilization data (health-based adjusters) and area level socio-economic data (non health-based adjusters). The instant application of health-based adjusters has limitations because they reflect a distorted provider structure and offer perverse incentives; therefore a gradual shift from using non health-based adjusters to health-based adjusters is preferred. The early phase of the capitation system also implies a strong presence of risk sharing arrangements and other complementary policies. Given that promoting efficiency and equity are to be pursued, the capitation approach outlined in this paper should serve as a guide to future Hungarian health care system reforms.
 Journal of Economic Literature (JEL) code: I28, G28, G32, H51

Eradication ofHelicobacter pyloriInfection in Outpatient Care

Introduction: The eradication of Helicobacter pylori infection is of importance in Hungarian health care system. Aims: The aims of the Ph. D. thesis are: 1. The primary, second- and third-line eradication of Helicobacter pylori in outpatient practice; 2. Meta-analysis of the Hungarian and European eradication results; 3. The assessment of the quality of life in functional dyspepsia. Methods: 1. Six primary regimens were evaluated in 3 open, controlled, prospective, single-center trials in duodenal ulcer patients. The regimens given were: a) omeprazole, amoxicillin, metronidazole, n = 48; b) omeprazole, clarithromycin, tinidazole, n = 52; c) pantoprazole, amoxicillin, clarithromycin, n = 48; d) ranitidine bismuth citrate, clarithromycin, n = 51; e) lansoprazole, amoxicillin, clarithromycin, n = 60, and f) ranitidine bismuth citrate, clarithromycin, metronidazole, n = 61 cases). Regimens c) and f) were given in a cross-over manner as second-line treatment in 134 cases. Pantoprazole-based quadruple therapies containing either nitrofurantoin or bismuth subsalicylate were given as third-line regimens in 41 cases. 2. The meta-analysis of the Hungarian full papers and abstracts published between 1993 and 2002 and that of the European abstracts published between 1997 and 2004 at the European Helicobacter Study Group, United European Gastroenterology Week, Digestive Disease Week and World Congresses of Gastroenterology meetings was performed. The pooled eradication rates and combined odds ratios were calculated in groups of similar regimens. 3. The quality of life was assessed by the Functional Digestive Disorders Quality of Life Questionnaire in 123 healthy subjects and patients with Helicobacter pylori positive ( n = 101) and negative ( n = 98) functional dyspepsia patients, treated by regimen c) or cisapride. Results: The eradication rates on an intention-to-treat basis were: a) 51.2%, b) 72.3%, c) 80.8%, d) 80.3%, e) 78.3%, f) 78.7%. Regimens c) and f) given as second-line treatment achieved 65.2%, and 60.3%, respectively. Quadruple treatments obtained 61.9% and 55.0% as third-line therapies. 2. The meta-analysis showed that proton pump inhibitor/ranitidine bismuth citrate based primary triple therapies achieved eradication rates > 80% both in Europe and Hungary. Regimens containing clarithromycin and amoxicillin obtained eradication rates of 81.5% in Hungary and 79.6% in Europe. Combination of clarithromycin and a nitroimidazole was efficient in 82.8% and 84.2%. 3. The quality of life was impaired in functional dyspepsia. Eradication or prokinetic treatment improved significantly ( p = 0.0001) the quality of life after 6 weeks and 1 year. The effect size at 6 weeks was 1.48 and 1.35. Conclusions: Proton pump inhibitor/ranitidine bismuth citrate-based primary therapies achieve eradication rates around 80% in outpatients care setting. Second- and third-line regimens were less efficient. The meta-analysis of the Hungarian and European results proved the validity of the Maastricht consensus statements. Impairment of the quality of life in functional dyspepsia is improved by eradicating the infection or prokinetic therapy.

Web-based laboratory service

The internet has revolutionized not only the clinical laboratory operation but has also made laboratory service more user friendly. With its help the laboratory can provide precise and up to date information about the services and laboratory tests to offer, furthermore can provide insight into the different operating procedures. To provide an overview of the laboratory services in an easily accessible manner, promote efficient information transfer to the clinicians, familiarize the test repertoire in different classifications, provide information on tests requiring special sampling and transportation, create a search engine for tests performed, provide in a downloadable format the different order forms and the specifications of the newly introduced tests, provide links to websites relevant to the field, familiarize with the departments educational and research activities. With the creation of our own website we have provided clinicians and students with a practical, easily accessible, user friendly tool that provides details of our services and activities, furthermore the number of preanalytical queries has also reduced significantly. Unfortunately, in the present Hungarian healthcare system few users utilize adequately the possibilities offered by the internet, however, departments like ours and others are making efforts to change this tendency.

THE EXPORT OF NURSES FROM EUROPE TO THE UNITED STATES

We would like to highlight the main conclusion by Polsky et al.1 on the similar qualifications of nurses trained within and outside the United States. The nursing shortage is an important phenomenon not only in the United States but also in Europe.2 Since the fall of socialism in Hungary in 1989, the country has become an important source of well-qualified nurses for Western countries. During Hungary’s economic reforms in the early 1990s, nursing education was elevated from diploma level to degree level to match that of other countries in Western Europe. Until 2005, the development of the bachelor of science in nursing program in Hungarian universities was supported by staff at Case Western Reserve University (Cleveland, Ohio) to make it more compatible with the degrees available in Western countries.3 In 1990 there were no degree-holding nurses in the Hungarian health care system (with the exception of the few nursing director posts); by 2000, 2567 out of 62000 nurses in Hungarian health care institutions (mainly hospitals) held a bachelor of science in nursing. Since the mid-1990s it has been compulsory for each hospital department in Hungary to employ at least 1 nurse with a bachelor’s degree. This requirement has accelerated the acceptance of degree-holding nurses in health care institutions. In 2000 nearly all leading domestic nursing posts were held by degree-holding nurses; in subsequent years, an increase in the migration of nurses (as a result of declining domestic opportunities) was detectable by the number of diploma supplements (a document issued to outline the education received) issued in English.4 Since 2000 the master of science in nursing degree has been available in Hungary in an attempt to make domestic nursing careers more attractive. The focus of this complementary degree is on management, education, and research.5,6 In 2006 the Doctoral School of Health Sciences at the Faculty of Health Sciences, University of Pecs (Pecs, Hungary), was established with the aim of strengthening research in nursing and in health sciences.7 In recent years, the number of new applicants to Hungarian universities who are interested in earning a nursing degree has slightly but steadily declined. If the experienced nursing workforce with bachelor’s or master’s degrees continues to move elsewhere for job opportunities, the Hungarian health care system will be threatened.8 The right of individual nurses to migrate and the ability of nations to keep nurses that are citizens both should be considered in order to find a sustainable balance in migration. Figure 1 Emma Trochez, with Goodwill Industries of South Florida in Miami, trims a US interment flag on March 24, 2003. This South Florida non-profit serves as a major supplier of fatigues for the US military, as well as the licensed maker of the interment flag ...

Cost accounting methodologies in price setting of acute inpatient services in Hungary

On the basis of documentary analysis and interviews with decision makers, this paper discusses the cost accounting methodologies used for price setting of inpatient services in the Hungarian health care system focusing on sector of acute inpatient care, which is financed through the Hungarian adaptation of Diagnosis Related Groups since 1993. Hungary has a quite sophisticated DRG system, which had a deep impact on the efficiency of the acute inpatient care sector. Nevertheless, the system requires continuous maintenance, where the cooperation of hospitals, as well as the minimisation of political influence are critical success factors.

The Impact of the EU Enlargement on the Hungarian Health Care System

The Impact of the EU Enlargement on the Hungarian Health Care System

Benefits and entitlements in the Hungarian health care system

This contribution considers entitlements and benefits in the Hungarian health care system. After a brief introduction to the organizational structure of the system the decision-making processes are discussed in detail, including the most important actors, types and pieces of legislation, formal structures, decision-making criteria, and outputs in terms of benefit catalogues. Within the two main public financing systems (social insurance and tax-funded services) there are four types of regulatory regimes: (a) traditional political decision making, (b) price negotiations, (c) updating of classification systems for payment purposes, and (d) the procedure for the inclusion of registered medicines in the scope of the social health insurance system. As an example we discuss the benefit regulations and benefit catalogues in the category of services of curative care (HC.1) of the OECD classification of health services.

The inequity of informal payments for health care: The case of Hungary

As in most countries of Central and Eastern Europe, informal payments have been a characteristic feature of the Hungarian health care system both during and since the demise of Soviet type socialist rule. Although informal payments continue to be so characteristic in the region, little empirical evidence exists on their scope or working. As far as equity is concerned, it has sometimes been suggested that physicians play a ‘Robin Hood’ role and subsidise the poor at the expense of the rich. With the aid of an interview survey of a representative sample of the Hungarian population, we examine the distribution of the burden of informal payments across income groups. Results indicate that informal payments are a highly regressive way of funding health care, with Kakwani progressivity indices of −0.38, −0.39, −0.35 and −0.36 for GP, outpatient specialist, hospital, and total care, respectively. The finding that people with lower income pay proportionally more for public health care through informal payments underlines the emptiness of the ‘Robin Hood’ claims and the need for reform.

Recent Changes in the Hungarian Mental Health Care System

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Consensus and health policy in Hungary.

The Hungarian health care system is scheduled to undergo dramatic structural changes, emphasizing preventive medicine, health education, and competition among providers.