The role of immunochemical testing for colorectal cancer

Structural Changes in the Hungarian Healthcare System Between 2000 and 2017

BACKGROUND

The rigid and old-fashioned structure of the Hungarian healthcare system has been discussed since the mid-1990s and is at the center of professional and policy debates. It is characterized by the too high number of acute care hospital beds in international comparison; access is regionally unequal; levels of progressive care are mixed; and there is a nonuniform emergency service system with unequal access to the emergency room, heterogeneous quality of care, and unexploited opportunities of modern health technology (eg, 1-day surgery, minimally invasive procedures, telemedicine).

OBJECTIVES

The aim of this study is to analyze the indicators of ongoing structural changes of the Hungarian healthcare system between 2000 and 2017.

METHODS

Data are derived from the Organisation for Economic Co-operation and Development Heath Statistics, Hungarian National Statistical Office, National Health Insurance Fund Administration and the database of the European Structural Funds. The methods used for the analysis are descriptive statistics, trend analysis, and longitudinal data.

RESULTS

The total number of hospitals beds showed a 32% reduction between 2005 and 2017. Parallel with this subsequent reduction of hospital bed capacities, we can see a moderate reduction (22.3%) in the number of discharged patients from hospitals: from 2005 to 2017, 2.55 million to 1.95 million. The average length of stay in acute hospital care has decreased from 6.3 to 5.1 days. About 25 to 27 small local hospitals lost their acute or short-term care profile (mainly intensive care units, internal medicine, surgery, and pediatric care wards) and became long-term care, chronic care, or rehabilitation profile hospitals.

CONCLUSION

Structural change is in progress in the Hungarian healthcare system, and some efficiency gains have been reached. Nevertheless, still there are significant potential efficiency gains in the better organization and management of health services in addition to the dissemination and better incorporation of modern healthcare technologies.

Development of health technology assessment in Central Europe

Once upon a time in the 1990s, if you wanted to do HTA in the Central and Eastern European countries (CEEs), you got yourself invited by Egon Jonsson and travelled to Stockholm to learn how to do HTA. There you met him and Prof. Banta and other HTA professionals from all over the world—very importantly, motivated healthcare professionals from all CEEs who were eager to learn HTA. These eminent founding fathers were always available, and were never tired if help or assistance was needed. During that time, the telephone number of HTA was known and used extensively, making it a real, living, informal HTA network. Formal HTA collaborations organized by them and funded by the European Commission, such as EUR-ASSESS, HTA EUROPE, ECHTA/ECAHI, were also crucial . . .

Colorectal cancer screening policy in Hungary

We read with great interest the excellent paper of Gutiérrez-Ibarluzea et al. on the review of current policies of screening for colorectal cancer in European countries (12).Colorectal cancer screening has been a hot topic in health technology assessment and medical decision making (13;15;18). The study by Gutiérrez-Ibarluzea and colleagues focused mainly on the “old” fifteen member states of the European Union; however, colorectal cancer represents a large epidemiological (3;11) and economic (4) burden for the society and the healthcare financing agency in Eastern European countries. We would like to highlight some important aspect of colorectal cancer screening in Hungary.

[The state of the colorectal screening in Hungary: lessons of the pilot programs]

In Hungary, colorectal cancer is the second most common malignant disease. Due to its natural history, colorectal cancer is particularly suitable for screening. At present, epidemiological evidences of the effectiveness of detection of the symptomless colorectal cancer and its precursors are only available for the demonstration of fecal occult blood, endoscopic methods are also in use. For mass screening, fecal occult blood tests are recommended. Guaiac-type chemical methods are widely criticized because of the lack of specificity. Out of the emerging technologies, immunochemical methods based on the antigenicity of blood proteins (hemoglobin) seem to be the most suitable. In the model programmes organized in the frame of the National Public Health Programme, an immunochemical method using two blood proteins (hemoglobin and albumin) have been used. The compliance was not more than 30-45%. About one-third of those with positive blood test refused colonoscopy. The programmes revealed a great number of adenomatous polyps and early cancers, and in the way, the effectiveness of the method has been proved. The model programmes are still continued. Before the continuous and gradual extension of colorectal screening, the validity of the specific method needs to be tested and proved in order to be recognized as a routine procedure for screening. There is a need to test the feasibility of total colonoscopy, however, to this effect the colonoscopic capacity in the country has to be further developed.