Hungarian Health Care Research Articles

Occupational health nursing in hungary.

This article is the first about occupational health nursing in Hungary. The authors describe the Hungarian health care and occupational health care systems, including nursing education and professional organizations for occupational health nurses. The Fundamental Law of Hungary guarantees the right of every employee to healthy and safe working conditions, daily and weekly rest times and annual paid leave, and physical and mental health. Hungary promotes the exercise of these rights by managing industrial safety and health care, providing access to healthy food, supporting sports and regular physical exercise, and ensuring environmental protection. According to the law, the responsibility for regulation of the occupational health service lies with the Ministry of Human Resources. Safety regulations are under the aegis of the Ministry of National Economy.

Attitudes of Hungarian Healthcare Professionals (Mds, Nurses) According To Cam Homeopathy: A Cross-Sectional, Qualitative Accumulated Survey's Data

Aim of the study: In Eastern-Central Europe, homeopathy has a long history starting from XIXth century which has however been interrupted and later renewed in 1997. A large number of physicians and pharmacists have been trained in homeopathy since. This survey is aimed to measure attitudes to homeopathy in Hungarian GPs and nurses for pediatric and adult population. Materials and methods: An identical original self-administered questionnaire was submitted in 2012 to 550 general physicians's nurses. 536 (98.9 %) women and 6 (1.1 %) men replied. Results: Approximately one third of GPs is using homeopathy. The usage of homeopathy is quite similar to other European countries in spite of the controversal and refusal habit of academic medicine. Effects of gender, age and location are weak and inconsistent. Discussion/Conclusions: Homeopathy has firmly been integrated into the Hungarian health care system and has sustained despite the worse economic conditions of the population and no public support from the official health insurance system (only private health insurance companies accepted it). Accumulated survey data were concluded with future achievements of harmonization in this CAM field. The life-style advice given by nurses can influence homeopathic usage among patients; further education is necessary for the ethical application of homeopathy and remedies after CEU-courses at University. We emphasize the ethical application of any CAM method, such as homeopathy for patients. CAM courses should be involved into curricula of nurses and MDs according to interest either in basic or in further education

Milestone in Hungarian organ transplantation: joining Eurotransplant

Hungarian organ transplantation reached a new milestone after half-a-century history, when becoming a full member of the 135-million Eurotransplant community this year. The transplantation of the five organs: kidney, liver, pancreas, heart and lung became a routine procedure. A handful of specialists performed nearly 7000 transplantations and doing so supported the evolution of a special branch of the Hungarian health care system. The author reports the latest results of the preliminary membership year, looking forward with great optimism by seeing new horizons with the advantages of the full membership.

Coping with work-related stress in health care professionals – strategies for prevention of burnout and depression

The prevalence of depression and burnout among health care professionals is high in Hungary. However, there is limited empirical data on disease prevention among these populations. This study aims at evaluating the mediating role of coping mechanisms in preventing depression and burnout. Cross-sectional survey among 1333 health care professionals. Participants completed self-administered questionnaires about their perception of work stress, burnout and depressive symptoms, as well as their preferred coping strategies. Analyses were performed using structural equation modelling. The prevalence of severe depression and lack of personal accomplishment was 5.6% and nearly 50%, respectively. Work stress predicted symptoms of burnout and depression both directly and indirectly through the mediation by coping strategies. Of the coping strategies, cognitive restructuring, which accentuates the realistic assessment of challenging situations, was found to reduce the probability of the development of burnout and depression symptoms. This study provides further data for the development of cognitive interventional strategies and highlights the significance of these strategies in the prevention of depression and burnout among Hungarian health care professionals.

Addressing Equity in Health Care at the Public-Private Intersection: The Role of Health Rights Enforcement in Hungary

This paper examines the role of the rights-based review in addressing inequities in access to health care. Focusing on the case of Hungary, the analysis intends to contribute to the debate about factors that bring about/sustain inequalities in health and health care at the public-private intersection and the role of law and rights-based litigation in addressing these inequalities. Towards this end, the paper presents first an overview of the Hungarian health care system. It then analyzes the scope and content of the right to health by discussing the constitutional protection of health rights and the right to health care guaranteed within the public health system. Further to that, the paper reviews the main mechanisms of rights enforcement in health care. It describes the health care litigation that has taken place in Hungary with focus on equity issues at the public-private intersection. The analysis is concluded by a discussion of the role of health rights enforcement in promoting equity in access to health care. The paper is a chapter of a book titled ''The Right to Health at the Public/Private Divide: A Global Comparative Study'', edited by Prof. Aeyal Gross and Prof. Colleen Flood, forthcoming by Cambridge University Press.

Exploring consumers’ attitudes towards informal patient payments using the combined method of cluster and multinomial regression analysis - the case of Hungary

BackgroundPrevious studies on informal patient payments have mostly focused on the magnitude and determinants of these payments while the attitudes of health care actors towards these payments are less well known. This study aims to reveal the attitudes of Hungarian health care consumers towards informal payments to provide a better understanding of this phenomenon.MethodsFor the analysis, we use data from a survey carried out in 2010 in Hungary involving a representative sample of 1037 respondents. We use cluster analysis to identify the main attitude groups related to informal payments based on the respondents’ perception of and behavior related to informal payments. Multinomial logistic regression is applied to examine the differences between these groups in terms of socio-demographic characteristics, as well as past utilization and informal payments paid for health care services.ResultsWe identified three main different attitudes towards informal payments: accepting informal payments, doubting about informal payments and opposing informal payments. Those who accept informal payments (mostly young or elderly people, living in the capital) consider these payments as an expression of gratitude and perceive them as inevitable due to the low funding of the health care system. Those who doubt about informal payments (mostly respondents outside the capital, with higher education and higher household income) are not certain whether these payments are inevitable, perceive them as similar to corruption rather than gratitude, and would rather use private services to avoid these payments. We find that the opposition to informal payments (mostly among men from small households and low income households) can be explained by their lower ability and willingness to pay.ConclusionsA large share of Hungarian health care consumers has a rather positive attitude towards informal payments, perceiving them as “inevitable due to the low funding of the health care system”. From a policy point-of-view, the change of this consumer attitude will be essential to deal with these payments in addition to other policy strategies.

Personalized medicine from the viewpoint of patients and their relatives

Our goal was to overview the situation of personalized medicine, especially to characterize the role of patient organizations. We embedded this process into the on-going procedures of the transformation of health care system, outlining the Hungarian and international tendencies. We introduce the exceptional role of rare diseases, among others the rare cancers, thanks to their special status. Some results of the recent Hungarian and international surveys are also demonstrated. The presented global tendencies give the frame for the necessary alteration of the Hungarian health care system. Beside the solution of the country-specific problems of our health care system, the main principles of the new paradigm of 21st century medicine are also influencing: personalized, participatory, preventive, predictive and proactive. The new medicine is continuously associated with the patients, instead of separated interventions. The changing of attitude is necessary for spreading these principles and also gives the basis of future medical service of society. The role of patient organizations is vital during this progress. The development is possible to the direction of patient-centred health care model by changing the structure of residential expenditure, even during the time of global financial crisis. However, a stronger community involvement is required. Good examples of this patient organization involvement are presented in the case of rare diseases, which can be, together with orphan drugs, the precursors to personalized medicine, paving the path to this direction. A closer participation of patients and their organizations is essential to transform the present health care system to the route of personalized medicine and to alter the public outlook.

The Costs of Organisational Injustice in the Hungarian Health Care System

The new Hungarian Labour Code allows informal payments to be accepted, subject only to the prior permission of the employer. In Hungary, the area most affected is Health Care, where informal payments to medical staff are common. The article assesses the practice on ethical terms, focusing on organisational justice. It includes an analysis of distributional injustice, that is, of non-equitable payments to professionals, on the distribution of payments depending on the specialisation and status of the doctor, on his or her rights to allocate Health Care resources and/or on how assertive he or she is. We show, by means of a content analysis of internet postings and of interviews with physicians, the feelings and attitudes of both patients and doctors—thus enabling us to trace interactional and procedural injustice and portray the main driving forces of informal payment with causal loops. We use a new approach (a system dynamics computer simulation) to demonstrate how informal payments influence therapy procedures. The example of treating the common skin disease of psoriasis examines the specific behaviour of doctors in their everyday practice and estimates the extent to which the prescription of unnecessary or more expensive therapy increases the costs. With this multi-method approach, we demonstrate that the legislation allowing informal payment represents bad ethics, since it enforces organisational injustice, creates mistrust between physicians and patients, decreases performance and increases the total costs paid both by society and the Health Insurance Fund. Informal payments distort the allocation of resources, enforce discrimination based solely on money, violate the concept of solidarity and limit Human Rights in terms of health.

1975 – Correspondence among emotional regulation, mentalization and burn-out at hungarian health care workers

Several studies have shown that excessive emotional involvement of health care professionals may lead to burnout (Zapf et al 2001; Brotheridge&Grandey 2002). As our perevious studies (Fülöp, Devecsery & Csabai 2012) also showed, medical and paramedical professionals who are prone to overinvolve in the interactions of the patients experiencing distress, may suffer from emotional exhaustion for long run. We looked for correlations between disturbances of emotional regulation, lack of mentalization, and intensive emotional distress. We used a descriptive approach, where a set of questionnaires were applied. The sample consisted of 200 health care professionals - nurses, and assistents for oxyology-, from all over Hungary. Questionnaires used: Maslach Burnout Inventory, (Maslach and Jackson, 1986), Interpersonal Reactivity Index (Davis, 1980), Difficulties in Emotional Regulation Scale, (Gratz és Roemer, 2004) and Secondary Traumatic Stress Scale (Bride 2003). Our research team developed a test for mentatalization consists of 3 pictures of provider/patient interactions, and exposed with different instuctions according to 3 levels of mentalization. Our preliminary results show that the “3-picture test”, as a global one, can be useful to measure the complexity of mentalization, its components, as spontaneous mentalization, emotional identification, and emotional anticipation. This test may help the further understanding of the relationships between emotional regulation and the phenomenon of burn-out.

Spending cuts and centralization in Hungarian healthcare as a response to the international financial crisis

The Bismarckian model of mandatory social health insurance scheme was replaced by a tax-financed system, closely resembling to the British NHS model. The network of hospitals previously owned by local governments was nationalized and the Ministry responsible for healthcare became the owner of the entire hospital sector. The right of patients to choose hospitals was strictly limited. On the financial side, the government has made cuts of public health expenditures in the order of 1% of GDP.

Evaluating the National Health Insurance database of Hungary from the aspect of a health insurance specialist

There is currently only one national database in the Hungarian health care system: the financial database of the National Health Insurance Fund. It includes all patients’ data of state-funded services since 2000, those for pharmaceuticals, health spas and suppliers for patient transport. Any information for scientific research purposes can be obtained from this database. The database for inpatient records is complicated, and it is difficult to make queries. On the basis of his ten-year-experience, the author outlines the typical errors, which hinder a correct query. Orv. Hetil., 2012, 153, 1234–1239.

Non-invasive respiratory unit in the Hungarian health care system

Treating patients with acute or chronic respiratory insufficiency still poses a major load on the healthcare system. Though there is evidence that treating these patients in high dependency respiratory units results in a shortening of hospital stay, reduces the need of intubation, and decreases mortality. In the Hungarian routine these patients are treated in general wards until the development of global respiratory insufficiency, when they are transferred to intensive care units. The authors present their first year experience on their novel Non-invasive Respiratory Unit established at Semmelweis University.

Health Expenditure Scenarios in the New Member States: Country Report on Hungary

This country report aims to give an estimation of the development of public health care expenditures in Hungary during the first half of the 21st century. The model used for analysis is the ILO social budget model. Since this model is a full budget model, it includes not only the expenditure side, but the revenue side also. The structure of the model is presented in Section 2 of this report following a discussion of the long-term projections recently prepared for the Hungarian health care system (Section 1). The third section contains a review of main databases used by the model, while the fourth describes the underlying assumptions and development of main variables of the baseline scenario. The second part of the same section discusses alternative assumptions, aiming to provide sensitivity analyses for the baseline scenario. Results of both the baseline scenario and sensitivity analyses are presented in Section 5. Section 6 summarises these results and draws conclusions, while the final section formulates some policy recommendations based on the findings of our model (Section 7).

Collaboration between researchers from academic and non-academic organisations

Throughout the reform process of the European university system, the importance of collaboration between actors at the academy and other areas of the economy and society are ever increasing, as evidenced by a growing number of co-authored articles and the number of citations to such works.This article analyses the characteristics of publications co-authored by Hungarian university researchers with non-academic partners. Scientometric indicators are used as primary methodological tools. Our sample was the publication output of 12 universities, which covers 90% of the university sphere’s publications, between 2001 and 2005 and was taken from the publications of Hungarian institutions of higher education appearing in the Web of Science database. The authors employed a new, important aspect in the cooperation activity of Hungarian universities: their connection with the non-academic partners. The selection and the institutional location of the co-authors resulted in an important database for further analysis. Based on the empirical analysis of the publication and citation performance data of 12 such universities the authors concluded that the proportion of citations to publications co-authored with either academic or non-academic partners is significantly higher for international partners than it is for Hungarian ones. For one publication, the proportion of citations to articles co-authored with foreign non-academic partners, such as firms or health care institutions, was five times higher than the number relating to papers co-authored with Hungarian firms or health care institutions. Higher citedness of the joint articles with the foreign country institutes than domestic partners are in harmony with observation in other countries. Generally the rate of the co-authored articles with non-academic partners is rather low. However it scatters to a great extent concerning the different universities. The presence or absence of medicine in the profile of the universities seems an important factor of that difference.

“Hannibal ante portas” – technical development and health care reorganization

Authors intend to analyze the impact of medical technical development on the Hungarian health care system and try to draw attention to potentially necessary measures for professional and structural health care reorganization.

The effect of financing on the allocation and production efficiency of the Hungarian health care system — Placing primary care into focus

The increased supply and the demand-driven explosion of global health care costs threaten the sustainability of health care services, mandating optimisation of cost-efficiency via health policy. As of July 1 2006, preventive-curative health care has been reimbursed using a centralised, closed prospective method; thus Hungarian health care providers operate budgets allocated through macro, mezzo or micro-level allocation mechanisms. Lacking sufficient incentives for patient care on the lowest level of care, production efficiency is the only tool left to increase efficiency. Nonetheless, one of the bigger challenges of the twenty-first century is managing chronic diseases that mandate continuous complex care encompassing all levels of care and the optimisation of patient referral methods. However, current allocation mechanisms have not yet reflected this paradigm shift. The paper discusses how capitation financing, by providing strict budgetary constraints, a framework for local political goals and enhancin...

A lakóhelytől függ az esély a jobb minőségű ellátásra – Az ellátáshoz való hozzáférés területi egyenlőtlenségei Magyarországon, a szürkehályogműtétek példáján

Az egészségi állapotban jelen lévő egyenlőtlenségek csökkentésének egyik hatékony eszköze az egészségügyi szolgáltatásokhoz való hozzáférés feltételeinek és a hozzáférés esélyegyenlőségének biztosítása. Az egészségügyi ellátáshoz való hozzáférés vizsgálatában a közfinanszírozott szürkehályogműtétek 2008. évi adatait vizsgáltuk. A kutatás során arra voltunk kíváncsiak, hogyan oszlanak meg az ellátási kapacitások és az ellátási típusok a szolgáltatást végző intézmények között, illetve milyen domináns útvonalak különíthetők el az igénybevételhez kapcsolódó betegmobilitásban. Regionális és kistérségi esettanulmányunkban külön elemeztük, hogy egyrészt az egészségügyi intézmények elérhetősége milyen mértékben van hatással az igénybevételre, másrészt mekkora különbség tapasztalható az utazási távolságban, időtartamban és költségekben akkor, amikor a beteg nem a lakóhelyéhez legközelebbi intézményben vette igénybe a műtéti szolgáltatást. A lakóhelytől függően nagy egyenlőtlenséget tapasztaltunk az intézmények elérhetőségében. A műtétek során a betegek nagy része nem a lakóhelyéhez legközelebbi intézményt kereste fel, ezzel vállalva az utazási és kiadási többletet. Közülük sokan a területi ellátási kötelezettség alapján, tehát a szabályokat követve utaztak a távolabbi ellátó intézménybe. A lakosság egészségügyi ellátással való elégedettségének növelésében a jövőben azt is vizsgálni kell, hogy milyen további tényezők befolyásolják a betegek orvos- és intézményválasztását.A tanulmány javaslatokat fogalmaz meg a térségi egészségügyi ellátórendszerek kialakításához, valamint kísérletet tesz egy olyan módszertan kidolgozására, amely segítségül szolgálhat a szakpolitikai döntéshozatalhoz.

Emigration and labour shortages: An opportunity for trade unions in the New Member States?

Emigration from the post-socialist states which joined the EU in 2004 and 2007 has reduced unemployment rates and created shortages of some skills. This should provide opportunities for trade unions to improve their situation, by facilitating union organizing and strengthening their bargaining position. Have unions grasped these opportunities? We adopt an actor-centred perspective to examine their strategies and actions in the public health care sector — strongly affected by migration — in Slovakia, Poland and Hungary. We argue that variation in union strategies depends mainly on the interplay of union capacities and state strategies. Slovak unions used the established sectoral bargaining system to obtain wage increases and to consolidate the bargaining machinery. In contrast, Polish unions gained wage increases through industrial action. Hungarian health care unions mostly failed to seize migration-related opportunities.

The medical career choice motivations — Results from a Hungarian study

Abstract Some decades ago being a medical doctor was characterized unambiguously as a profession that offers help and serves the patients’ needs during medical treatment. In today’s society, this image of the medical profession has been substantially changed. The present paper aims to examine medical career choice motivations and preferences of choosing speciality, in the light of current social and economic changes in Hungary. The study was carried out by using a voluntary, self-administrated, questionnaire among first-year medical students and resident doctors in four medical faculties in Hungary. The career choice motivations of the first-year medical students and resident doctors are similar and match to the traditional health profession career choice motivations. Nevertheless the first-year students consider high income as one of the most important factors. They appear more conscious and more ambitious regarding their future speciality choice. The Hungarian health care system and medical education must be prepared for the presence of students that are aware of the high market value of a medical diploma, have excellent language skills, and consider migration as one main factor in their motivation when choosing a medical profession.

Attitude of medical students to regulatory measures related to tobacco smoking

In some countries strict tobacco control measures successfully reduced the number of smokers. Although these measures do not have immediate effects, they may serve as investments in the future healthcare. Health care experts should take part actively in the decision making. To investigate medical students' relation to smoking and their attitudes about tobacco control measures. Authors applied the Hungarian translation of the Global Health Professionals Student Survey. Medical students from the first and fifth year answered its questions anonymously. Statistical analysis was performed with SPSS. Altogether 245 students completed the questionnaire. It was found that the knowledge of students about health damages caused by tobacco smoking was very good. However, a large number of students are exposed to tobacco smoke (68% of them at home and 85% at public places). Their opinion about tobacco control measures reflects recent law, as only 43% of the students would support a smoking ban in bars and discotheques. Hungarian health care experts have to take part with more effort in the prevention of tobacco smoking. Medical students have to be trained in this field.