[Impact of reorganization of the Hungarian system of intensive care units in 2012]

INTRODUCTION

In 2012, the Hungarian system of intensive care units was reorganized. During this process, multidisciplinary units were separated from observation units.

AIM

The author analysed certain indicators of the remaining intensive care units.

METHOD

The study was based on reports of National Health Insurance Fund between 2000 and 2015.

RESULTS

After reorganization the number of the multidisciplinary intensive care units decreased by 20% and the number of beds decreased by 10%. Due to the reorganization, both the case-mix index and the days of mechanical ventilation increased significantly in the multidisciplinary intensive care units. In 2000, 12% of the patients were discharged directly from the intensive care units to home, but by 2014, this figure decreased to 3%. The bed-occupancy rate of the intensive care units did not change fundamentally and it was under 80% in each calendar day. In addition to the ICD leading groups I and J, the rate of "Sine morbo" (U9990) diagnosis decreased from 0.7% to 0.2%. Similarly, the ratio of R group which describes only symptoms decreased from 1.7% to 1.1%. In contrast, between the interventions the number of fluid and electrolyte imbalances and respiratory monitoring showed more than twofold increase.

CONCLUSIONS

These results suggest that the reorganization was effective. The activity of the intensive care units has improved significantly, without disturbing patient care. The author suggests further analysis on the basis of the same criteria for other departments and the consistent continuation of the reorganization process. Orv. Hetil., 2016, 157(44), 1757-1761.

[Correlations between malignant breast cancer and breast screening in Hungary, based on the National Health Insurance Fund database]

The effectiveness of different screening programs can be characterized by the number of subjects taking part in the programs and the number of persons found positive. In this study the outcome of mammographic screening in Hungary was examined using data obtained from the National Health Insurance Fund database. The author posed questions whether breast cancer patients participated in screening before the discovery of their disease and, if yes, what was its outcome. It was also examined whether the disease had been discovered by screening or not. The results indicated that the willingness of subjects with breast cancer to participate in breast cancer screening was 38.8%, and this percentage did not significantly differ from that found in the average population. Because the percentage of screened subjects was less than the originally planned 60%, more efforts to increase willingness for mammographic screening should be invested. Data analysis also points out that providers do not always report correct ICD codes to health insurance authorities.

[The National Health Insurance database of Hungary from the viewpoint of a health insurance physician]

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.

The paranoia of data collection in Hungary and the health system

There is no integrated national health database in Hungary. The currently available database collects only important parameters relevant for funding, and these include data only from publicly funded providers. Patient data in different hospitals are inaccessible from outside but, because of insufficient filing and closures of hospitals, they are often not available in the hospital either. The author encourages to establish a medical database in Hungary by showing foreign examples, thus providing both medical staff and research with authentic patient data. Orv. Hetil., 2012, 153, 1158–1162.

Health related costs of smoking from the viewpoint of the Health Insurance Fund in Hungary

In recent times, the topic of smoking has been extensively debated in Hungary. A new Act has been issued for the protection of non-smokers and for the regulation of tobacco product distribution. Aims: The aim of the authors was to examine the economic burden of smoking on the society. Methods: According to wildly accepted estimates, 30% of the Hungarian population smokes. Smoking leads to the development of several diseases, for example, it is responsible for 90% of lung cancer cases. Results: 17.2% of the curative–preventive costs and 15% of the pharmaceutic costs are estimated to be spent on the health damages caused by smoking. In 2009, the Health Insurance Fund had to spend approximately 174.6 billion HUF for health damages including sick leave costs caused by smoking. Working days lost (patients on sick list) as a consequence of smoking decreased the GDP of Hungary by around 95 billion HUF in the same year. Literature suggests that smoking leads to a loss of approximately seven life years. Shortened life span might cause 594.9 billion HUF loss to the Hungarian economy not to mention the economical and emotional loss of the individual families. Conclusions: The authors estimated a total of 864.4 billion HUF loss to the Hungarian economy due to smoking. Orv. Hetil., 2012, 153, 344–350.

[Appendicitis in Hungary through the eyes of a health insurance specialist]

Appendicitis is the most common surgical disease. There is a very large literature for both its diagnosis and therapy.

AIMS

The author examined whether patients who were admitted with the diagnosis of appendicitis underwent surgery and what admission diagnoses were reported in cases of surgically treated patients.

RESULTS

In Hungary, there have been more than 92,000 appendectomies performed in the last eleven years. The proportion of laparoscopic surgery was 2.0% in 2000 and it rose to 18.8% in 2010. Using database of the national health insurance the author found that 5.6% of all surgically treated patients were referred to hospital with a diagnosis other than appendicitis. In contrast, 18.1% of the patients referred to hospital with the diagnosis of appendicitis were discharged without surgery.

CONCLUSIONS

In Hungary, there are large regional differences in the proportion of surgery.

[Some more parameters of utilization of intensive care units in Hungary]

According to the "Semmelweis plan for saving health care", "the capacity of the national network of intensive care units in Hungary is one but not the only bottleneck of emergency care at present". In an earlier report the author showed, on the basis of data reported to the health insurance that not in a single calendar day more than 75% of beds in intensive care units were occupied. There were about 15 to 20 thousand sick days which could be considered unnecessary, because patients occupying these beds were discharged to their homes directly from the intensive care unit. This study examines the functioning of intensive care units partly at the institutional level. The author shows how the number of days using mechanical ventilation and the number of direct discharges to the home of patients have changed, and proves that those institutions where the proportion of direct discharge to home so overnursing of patients was high, the rate of mechanically ventilated patients was low.

Reevaluation criteria for health care capacity allocation according to current legislation in Hungary

Act CXXXII of the year 2006 – amended several times – on the development of the health care system requires that health insurance authorities should regularly review utilization of the contracted capacity of professional medical care providers, and the need for change of capacities. The first such analysis should be carried out in 2013, according to the current laws in Hungary. The law lists 16 items, which are the basis for evaluation of the performance of providers. Among them some items are difficult to analyse specifically even for health insurance specialists. This study aims to review aspects of the reevaluation process and their associated concepts. Author wants to provide help for setting up the analysis in practice by going through and analysing the requirements of the law in detail. Orv. Hetil., 2011, 152, 1775–1781.

[Parameters of bed occupancy of intensive care units in Hungary]

According to the Semmelweis Plan for Saving Health Care, "the capacity of the national network of intensive care units in Hungary is one but not the only bottleneck of emergency care at present". Author shows on the basis of data reported to the health insurance that not on a single calendar day more than 75% of beds in intensive care units were occupied. There were about 15 to 20 thousand sick days which could be considered unnecessary because patients occupying these beds were discharged to their homes directly from the intensive care unit. The data indicate that on the whole bed capacity is not low, only in some institutions insufficient. Thus, in order to improve emergency care in Hungary, the rearrangement of existing beds, rather than an increase of bed capacity is needed.

Novel indicator for the assessment of hospital bed occupancy

In the past decades the bed occupancy of hospitals in Hungary has been calculated from the average of in-patient days and the number of beds during a given period of time. This is the only measure being currently looked at when evaluating the performance of hospitals and changing their bed capacity. The author outlines how limited is the use of this indicator and what other statistical indicators may characterize the occupancy of hospital beds. Since adjustment of capacity to patient needs becomes increasingly important, it is essential to find indicator(s) that can be easily applied in practice and can assist medical personal and funders who do not work with statistics. Author recommends the use of daily bed occupancy as a base for all these statistical indicators. Orv. Hetil., 2011, 152, 797–801.

Characteristics of patient pathways in Hungary

Over the past four years, there were nearly 250 million registered visits of insured patients in outpatient services in Hungary according to the database of the National Health Insurance Fund. In the process of renewal of health care system it is extremely important to analyze the characteristics of patient pathways. With the analysis of registered visits between 2007 and 2010 the author shows that 65%-96% (average 86%) of the insured patients used the services of outpatient care in the county of their living. This figure was the lowest (65%) in Pest County, which is the service area of several providers located in Budapest. Author presents and analyses the characteristics of patient pathways in different counties of Hungary. Orv. Hetil., 2011, 152, 338–343.

[The shutdown point and the output volume limit (OVL) in the present situation of healthcare in Hungary (or a little economics for practicing physicians)]

In the present situation of health care, financing has become so complicated that the treating doctor has to know not only his profession but also has to consider the different regulations, laws and book of rules. The work of the physician cannot be carried out only through the fact that he is a master of his art, that is healing. All healing practice, diagnostic abilities, intuition, empathy and other things are in vain: if he is not familiar with the basics of financing he can lead his institution to insolvency. This article tries to give a view of a small part of financing, the output volume limit (OVL) from another aspect. According to the basics of economy and general rules of leadership it tries to show up the practical difficulties of the output volume limit. The study enlightens that by defining the output volume limit one has to consider the shutdown point of the hospital and knowing this, the actual output volume limit should be defined in the way that it does not make the proper activity of the hospital completely impossible.