Hungarian Health Care Research Articles

Student nurses, midwives and health visitors' attitudes, knowledge, and experience of complementary and alternative medicine in Hungary

IntroductionComplementary and alternative medicine (CAM) has become an important part of healthcare. This study aimed to compare three groups of health care students' attitudes towards, knowledge of, personal use of, and opinions about the integration of CAM into higher education and health care in Hungary. Comparisons were made between those participating and those who did not participate in a Complementary Medicine (CM) course as an optional course during student training. MethodsA survey of the 314 full time students (nurses, midwives and health visitors) were asked to take part in an online survey using a self-complete questionnaire. Data were analyzed using descriptive statistics. ResultsStudents' attitudes towards CAM were positive. The most commonly known alternative methods were massage, relaxation, acupuncture, herbal medicine and meditation. The most commonly personally used and perceived as being effective CAM modalities were herbal medicine, massage and relaxation. Most students believed that the integration of CAM into higher education and into health care is necessary. There were no differences in attitudes towards CAM between students who participated and those who did not participate in the CM course. Participants considered the course to be useful and reported higher knowledge about three CAM modalities and preferred formal education as information sources. ConclusionHealth care students are open to learning CAM. Increasing the number of health care students in the CM courses would result in ensuring that future health care professionals obtain reliable knowledge about CAM practices which may in turn make their work more effective.

A proposal for introduction of Europeristat-compatible information system aiming a unified quality control of obstetrical and perinatological care in Hungary

It is a regrettable deficiency in the Hungarian healthcare that the culture and the system of quality control of cure have not been formed (except for a few subspecialties, units or wards). If hospital wards do not have a national, professionally unified and modern information system presenting the most important quantity and quality indicators of their medicinal activity annually, a stable basis for definition of future tasks is absent. The author puts forward a proposal for the establishment of the information systems for different professional fields. On the basis of experience of perinatological information system operating for over 3 decades in Borsod-Abaúj-Zemplén county, he also proposes introduction of a nationally unified, Europeristat-compatible information system following Tauffer-statistics which may serve as a uniform quality control of obstetrics and perinatological care, as well as introduction of its base, the dataform "TePERA" (Form of Obstetrics and Perinatological Care Risk).

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.

Postpartum Mental State of Mothers of Twins

Abstract Twin birth is a relevant risk factor for postnatal depression (PND). The primary objective of our study is to reveal the prevalence of suspected cases of depression and to identify some background factors among mothers of twins. We applied convenience sampling method within a retrospective, quantitative study among mothers given birth to twins for six months, but, at least, three years. The participants completed the self-administered, modular questionnaire and the standard EPDS questionnaire anonymously. 35% of mothers of twins reached or exceeded the threshold value for depression following the first six months after delivery. No significant difference was found in the prevalence of the suspected cases among the primipara and multipara (p=1.000). At the same time, artificial conception proved to be a significant risk factor (p= 0.019). Distraught family life (p=0.001) and unfavorable changes in a domestic partnership (p=0.009) increased the prevalence of the suspected cases of depression significantly. The health visitor is the only person who knows the hierarchy of families with their weaknesses and strengths in the Hungarian primary health care; therefore, her role is unquestionable in the recognition of maternal mood disorders. The health visitor compares the scores of the EPDS questionnaire with the experiences during family visits, and with all of these facts, she refers the person in need to a specialist.

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.

Does the Implementation of Official User Charges Help to Eradicate Informal Payments - Lessons to be Learnt from the Hungarian Experience.

User fees for health care services are a frequently applied policy tool to improve efficiency by controlling demand and contain costs. It is also applied to increase resources for health care, especially when public resources are limited or the increase of income-related contributions is not feasible or not desirable. In addition, in Central and Eastern European (CEE) countries, where informal payments are widespread, the introduction of user fees is often promoted by politicians and policy makers as a potential policy tool to eradicate or “formalize” informal payments (1). Informal payments are unofficial cash payments or gifts in kinds directly given to the health care personnel before or after using health care services. The literature on informal payments suggests that these payments violate the idea of transparency in health care financing and the accountability of providers, which results in an inefficient use of health care resources and inequalities in access to health care Furthermore, informal payments create adverse incentives for their beneficiaries, which can be in conflict with the government’s policy objectives. (2). Thus, in the last decades in the CEE countries, several policies have been implemented to eradicate these payments, including the introduction of official user fees for health care services. However, there is no evidence that supports this expectation. On the contrary, there is evidence to suggest that patients continue to pay informally after the introduction of user fees (3–5). In this case, user fees induce a double financial burden on patients, aggravating the existing problems caused by the informal payments. This makes user fees even more unpopular among the public. According to the OECD Health Statistics in Hungary, the total health expenditure accounts for 8% of the GDP in 2012, with a per capita expenditure of 1,358 USD, which is lower than the OECD average. The share of out-of-pocket payments in total health expenditure has increased considerably during the last decades, and has reached 28.3% in 2012, and accounts for about 5% of the total household expenditure. This level is one of the highest among European OECD countries. Above 80% of these payments are co-payments for pharmaceuticals (80%). There are no official co-payments for health care services, however informal payments are widespread. Hungarian health care consumers have been paying informally for medical services on a routine basis, especially in in-patient care. According to a study carried out in 2010 around one-fifth of the respondents who used physician services during the last 12 months, made informal payments, on average 60 €, and almost half of the respondents who were hospitalized during the last 12 months, paid informally on average 130 € (6). Studies suggest that the scale of these payments has not changed considerably during the last two decades. (7). In 2007 in Hungary, official user fees were introduced for the use of health care services covered by the social health insurance. The introduction of these fees was one element of the reform package to contain health care cost. According to the documented policy objectives, it was expected that official fees will contribute to the eradication of informal payments (8). Although the amount of user fees was relatively low (about 1 € per physician visit and per day spent in hospital), the implementation met with strong political opposition and unpopularity among the public. One year later, in April 2008, the payments were abolished as a result of a population referendum initiated by the opposition party in the parliament, where more than 80% of the voters supported the abolishment of the fees (8). The introduction and abolishment of users fees in Hungary can be considered a natural experiment, and enable us to study the association of formal and informal charges. The aim of this paper is to summarize findings on this issue based on studies carried out to examine the Hungarian case, and draw some policy conclusions.

Selection of Authentication Systems for Hungarian Health Care, Based on Physiological Study (Part II.)

The actuality of the topic indicated in the title comes from more and more events where the verification of identity might be required. Health-care is an important part of critical national infrastructures. A primary task of the protection of critical information infrastructures consists in the access control of data managed by IT system where the identity-authentication forms an important part. For this reason, the technologies considered suitable for use and their supporting means are listed. After examining and comparing the relevant parameters, the optimum solution for the authentication procedures in the Hungarian health care system is specified. First of all, the modern and efficient biometric identification processes are examined; however, the possession-based Radio Frequency Identification (RFID) as an additional system is also studied. Due to the well-known problems of passwords and chip cards. They were deliberately omitted during the system planning and efforts were made to exclude the human factors from the planned authentication system as much as possible.

Selection of Authentication Systems for Hungarian Health Care, Based on Physiological Study (Part I.)

The actuality of the topic indicated in the title comes from more and more events where the verification of identity might be required. Health-care is an important part of the critical national infrastructures. A primary task of the protection of critical information infrastructures consists in the access control of data managed by IT system where the identity-authentication forms an important part. For this reason, the technologies considered suitable for use and their supporting means are listed.After examining and comparing the relevant parameters, the optimum solution for the authentication procedures in the Hungarian health care system is specified. First of all, the modern and efficient biometric identification processes are examined; however, the possession-based Radio Frequency Identification (RFID), as an additional system, is also studied. Due to the well-known problems of passwords and chip cards, they were deliberately omitted during the system planning and efforts were made to exclude the human factors from the planned authentication system as much as possible.

Hospital bargaining in the wake of management reforms: Hungary and Slovakia compared

This article analyses the impact of new public management on employment relations in public healthcare in Hungary and Slovakia. We argue that hospital corporatization – a process which changed the ownership structure and management of public hospitals without privatization – created an opportunity for institutional change in collective bargaining. However, the interaction between hospital owners and managements, the state and trade unions accounts for the absence of major institutional change. Instead, corporatization helped maintain bargaining coordination in Slovakia and bargaining fragmentation in Hungary.

Third-country nationals in the Hungarian public health care sector

Third-country nationals in the Hungarian public health care sector

National Interest and European Law in the Legislation and Juridical Practice on Health Care Services – In the Light of the Reforms of the Hungarian Health Care System

National Interest and European Law in the Legislation and Juridical Practice on Health Care Services – In the Light of the Reforms of the Hungarian Health Care System

National Interest and European Law in the Legislation and Juridical Practice on Health Care Services – In the Light of the Reforms of the Hungarian Health Care System

The priority of the national interest in the field of the health care policy is secured by the rules of the TFEU, the Charter of Fundamental Rights of the European Union and by the secondary law as well. Although several market-type and pro-competitive solutions have appeared, they can have only limited influence on the national systems. The main reasons of the limited influence of the EU regulations are the primary responsibilities of the Member States, the widely applicable public health exceptions, and the limited application of the EU competition rules. Although the national legislation is the determinative, the EU regulations on the free movement of persons and services could be applied in the field of the health care services. This principle was recognized by the landmark decisions of the Court of Justice (ECJ). The Directive 2011/24/EU is based on these principles and a limited competition has evolved. Because the competition is limited and the creation of a single European health care area has just begun, the “silent revolution” of the public service provision has a minor importance. The practice of the ECJ has been focused on the use of the cross-border services and the Member States have had a broad margin for the organisation and management of this public service. The role of the European legislation on the competition is limited in this field as well. Therefore the strong centralization of the Hungarian health system from 2011 to 2013 may be in harmony with the EU legislation, although the competition at the national level is not promoted by the reformed Hungarian rules on health care.

International patients on operation vacation - perspectives of patients travelling to Hungary for orthopaedic treatments.

The importance of cross-border healthcare, medical and health tourism plays a significant role in the European health policy and health management. After dentistry, orthopaedic treatments are the leading motivation for seeking care in Hungary, as patients with rheumatic and motion diseases are drawn to the thermal spas and well-established orthopaedic centres. This paper aims to gain insight into foreign patients' perspectives on their experience of having sought medical tourism in orthopaedic care in Hungary. A patient survey was conducted in 2012 on motivations for seeking treatment abroad, orthopaedic care received and overall satisfaction. In addition, health professionals' interviews, and 17 phone interviews were conducted in 2013 with Romanian patients who had orthopaedic treatment in Hungary. Finally, medical records of foreign patients were analysed. The survey was completed by 115 participants - 61.1% females, mean age= 41.9, 87% Romanian origin. Most of the patients came to Hungary for orthopaedic surgeries, e.g. arthroscopy, knee/hip prosthesis or spinal surgery. 72.6% chose Hungary because of related to perceived better quality and longstanding culture of Hungarian orthopaedic care. Over 57% of patients reported being 'very satisfied' with care received and 41.6% 'satisfied'. The follow-up interviews further reflected this level of satisfaction, therefore many respondents stating they have already recommended the Hungarian healthcare to others. Based on the findings, patients from neighbouring regions are increasingly seeking orthopaedic care in Hungary. Patients having orthopaedic care are highly satisfied with the quality of care, the whole treatment process from the availability of information to discharge summaries and would consider returning for further treatments.

Contribution of clinical trials to gross domestic product in Hungary.

AimTo determine the contribution of clinical trials to the gross domestic product (GDP) in Hungary.MethodsAn anonymous survey of pharmaceutical companies and clinical research organizations (CROs) was conducted to estimate their clinical trial-related employment and revenues. Clinical trial documents at the National Institute of Pharmacy (NIP) were analyzed to estimate trial-related revenues at health care institutions and the value of investigational medical products (IMPs) based on avoided drug costs. Financial benefits were calculated as 2010 US $ purchasing power parity (PPP) values.ResultsClinical trials increased the revenue of Hungarian health care providers by US $165.6 million. The value of IMPs was US $67.0 million. Clinical trial operation and management activities generated 900 jobs and US $166.9 million in revenue among CROs and pharmaceutical companies.ConclusionsThe contribution of clinical trials to the Hungarian GDP in 2010 amounted to 0.2%. Participation in international clinical trials may result in health, financial, and intangible benefits that contribute to the sustainability of health care systems, especially in countries with severe resource constraints. Although a conservative approach was employed to estimate the economic benefits of clinical trials, further research is necessary to improve the generalizability of our findings.

Medical doctors in Hungary: 30 years after graduation. Data on lifestyle, morbidity, demography and differences between specialties.

There are few studies from East and Central European countries on health-status, lifestyle and social circumstances of medical professionals. We evaluated data of a cohort of physicians who had graduated 30 years ago in Hungary and compared the data of their professional carrier, life style, health outcomes, and medical specialties. Questionnaires compiled by an expert group and filled in by 208 physicians (83 men and 125 women) were analysed. Men mostly work as surgeons, women were mostly employed as primary care specialists. Women changed their specialty and/or place of work more often than men. Male primary care physicians had more children than women and others specialists. At graduation, most of them had a normal BMI. Since then, a significant increase in weight and BMI was observed in both genders and across all specialty groups. The largest increase in body weight and BMI (mean 5.27) was recorded among female primary care physicians. Recorded physical activity was low in general, with male primary care specialists being most active and female primary care physicians the least. Female doctors in surgical specialties had longer resting time. Male physicians rarely participated in regular health screenings. The incidence of hypertension was higher than the Hungarian national average for that age. About 5% of primary care physicians identified themselves as regular smokers. Abstinence and regular daily alcohol consumption were reported in equal ratio. Burn-out symptoms were rarely experienced. This generation had started its medical profession before the significant progressive changes in the medicine occurred in the last decades. While physicians do not always follow their own professional advices, their lifestyle proved a little bit healthier than that of the population at large, especially for women and their health outcomes, except hypertension, were also better. In general, they were not satisfied with the financial and working conditions of the recent Hungarian healthcare system.