Hungarian Health Care reform 2006 -2007 George Harmat

Hungarian Health Care reform 2006 -2007 George Harmat

Necessity of changes • Our health care framework formed between 1989 -1993 and since then no changes • Everybody are dissatisfied with the present situation • Patient dissatisfied because service quality and attitude Providers: dissatisfied, underfinancing, lost of prestige Politicians are dissatisfied : • Wrong outcome, low efficiancy • bed health status indicators • Permanent deficit factory • Horror of the budget • Permanent conflict unlikely fast success

Basic problems • The National Social Insurance Company is not separeted from the State Budget • The Ministry of Finance always use it as a reserve of the State Budget • The Health Care Budget every year underplanned and overspended • Hungarian Social security card numbers more then 15. 000 • We have a large Hungarian speaking diasporas about 3. 500. 000

Some other facts • Structures wore not changed properly according – needs, – Technological developments, – population needs • The present structure not only unfair but unable to survive because – – – Impossible to finance Human resorces are few using experts but impossible to keep Working Time Directiva in the same time Standard quality level not granted in this structure Sweeping changing Imperative

Health Care status and demographic data

Average life expectency for men at birth 80 75 Hungary Former EU-members 70 New EU- tagok 65 60 1970 1980 1990 2000 2010 Forrás: WHO EUR

Age profile changes Forrás: KSH Demográfiai Évkönyvek

Structure and functioning

Aktiv hospital beds per 100. 000 people Forrás: WHO HFA Database 2006.

Aktiv hospital cases per 100 people Forrás: WHO HFA Database 2006.

Aktiv and chronic hospital beds for 10. 000 inhabitants

Budapest • Population : • Area : 1. 698. 106 person (KSH 2006. 01. ) 525, 1 km 2 (KSH 2006. 01. ) • Hospital numbers: 49 • Hospital care centers : 91 • For one hospital site /km 2: 5, 77 km 2/hospital. (using this density in Hungary we need 16. 051 unit)

X-ray equipment numbers / 1. 000 people (2003)

Cesarian section rate in different regional hospitals 2005 -ös OEP elszámolási adatok és KSH lakosságszám alapján

Tonsillectomy rate under 14 years old children 2005 -ös OEP elszámolási adatok és KSH lakosságszám alapján A betegek lakóhelye szerint

Financing

Support in kind expenditure in 2005. (millió Ft) (1): Primary care, midwife, dentist

Public medicine expenditure rate in OECD countries

Medicine consumption box/capita (2004) Forrás: OECD

Basic problems in the Hungarian Health Care • • • Serious resource gap Not local or transitoric problem, Will not solving itself Not only lack of capital but Ascendent lack of human resource deficiency.

World tendencies • Health Care service „usual” (former hungarian ) level are unable to finance because of the technology development and lack of sources. • All over the world use controlling of the budget: – Decreasing capacity of services, – Service packege reform to srinkidge, – Providers more senzitive for expenditure, – Patients more senzitive for extra fees -payment). (co

2006 – Year of Health Care reforms • Important developments in the field of Hungarian Health Care reform : – So called Green Book discussion in professional and social level , – former untachable topics came into the floor, – basic steps for social acceptance – Radical changes induction in parlament level; – Healt Care insurance reform discussion is beginning. (2007)

The Health Care Insurance Authority • 1 st of January 2007 Healt Care Insurance Supervisory Board was introduced (central office under supervision of the Health Care Miniszter • This Authority controll payments, – proper using of contributions – effeciency and quality of sevices. • Its influence extends to the all Health Care system ( private and public )

Making three level of health care insurance packedge • Combination of solidariti and selfgovernance : – Basic: for every people staying in Hungary independent is there insured or not. – Insurance packedge: insured people with or witout co-payment. – Access contemporary packedge: extra plus insurance additional fee and services.

Health Care service financing F i n a n c e Individial Community Wellness, fittness Treatment – prevention services State Emergency Service s p e k t r u m Recreation , extra

New changes from 15 st of February • Vizit fee and hospital day care fee (300 Huf-1, 2 Eu) • Free for children under 18, chronic patient, cancer patient, etc about 4 Million peope ( 40%) • No fee for screening and emergency • Free after 20 meeting or 30 days • Extra charge if patient would like to go not the proper hospital or earlier (fee: 30% of the treatment fee max 100. 000 huf-40 Eu)

Reform chages in 2007 • Every providers has to give an informative hospital bill • More serious control of Medical insurance card ( about 800. 000 citizen has no valid one) for the end of this year they has to cower their fees or will pay • Large sortiment of drugs could buy outside of phamacy(drug store, petrol station ) • Hospital pharmacies got equivel right for purchesing

Weight-point Hospitals • 39 hospitals and Medical Universities (4) designated as special ones give service 24 ours every day, cover all the specialities • Originally were 21 -(50) at least 39 durig the lobby effect • Some of them is not functioning properly • They could be reach within 45 minits 50 km round • The progressivity system has to be reorganize

Localization of weight – point hospitals

Some hospital totally close down • • • National Institute of Psychiatry Pediatric Institute of Svábhegy Schöpf Mérei Maternal Hosp. Privatization St. Rókus Hospital Ralway-Army-Police –hospitals and Postgraduate Medical University will merge • Budai Childrens’ hospital turn to chronic 100 beds

Other Hospitals loose active beds turning to chronic and rehabilitation • In the country about 16000 active beds will disappear or turn into cronic or rehabilitation beds • In the capital formerly we had 2074 pediatric beds ( including maternity and PIC) • From 1 st January will be 1047 active beds changes wil finished for the end of the year • Birth rate only 96000/year

Hospital beds in Hungary jelenlegi krónikus ágy tervezett krónikus ágy jelenlegi aktív ágy tervezett aktív ágy

Human resources problems • About 6000 health care workers loosing their job • 1600 Medical doctors have to move or go to pension • In the same time about 2500 medical professionals are missing • Government compensation planning 7, 500. 000. Huf-30. 000 Eu.

What will be in the near future • Hospital structure will change : – Smaller capacity but better quality more efficient finacing system and human resorce service, – Capacity will tailoring to requests. • Outpatient service will more important: – Outpatient clinics and regional centers give service to replace former hospital treatment – Primary care should be more integrate, Gate keeper function and prevention will stronger. • Medical informatic development will supported and use as an integrated informatic system.

We are facing in the 2007 • • New minister of Health Painfull changes in the hospital structures Patients are searching their service places Medical professionals looking for job Managers try to keep the budget Local authorities searching better position Regional authorities making new agreements to reorganize their health services

Thank you for your attention