A Sebestyén

Epidemiology of osteoporosis related fractures in Hungary from the nationwide health insurance database, 1999-2003

SummaryThe Hungarian national health insurance database was screened for fractures of patients aged 50–100, 1999–2003. On average, there were 343 hip, 1,579 forearm, 342 proximal humerus, 48 inpatient vertebral and 2,459 other fractures/100,000 inhabitants/year.IntroductionThe incidence of fractures differs among populations. Our aim was to study the incidence of fractures in Hungary, focusing on classical osteoporotic sites and to compare the results with those of other European countries.MethodsThe Hungarian National Health Insurance Fund database, covering 100% of the population, was screened for fractures of patients aged 50–100, 1999–2003. The search of vertebral fractures was restricted to those admitted to hospital. A gender and age-matched comparison was performed with available data from Europe.ResultsThere were mean 343 hip, 1,579 forearm, 342 proximal humerus, 48 inpatient vertebral and 2,459 other fractures/100,000 inhabitants/year; the female/male ratio was between 1.2–2.4. Multiple fractures occurred in 23.1% of the cases. Hip fracture incidence in Hungary lies between the rates of northern and southern countries of Europe.ConclusionsOur study offers nationwide epidemiological data on fractures in Hungary. The incidence of fractures increased by age, regardless of the type of fracture. Incidence of hip fractures in Hungary fits in the previously established geographic trends in Europe. Our results fulfil a need for fracture data from Central Europe.

Financing of health care services in Hungary.

In this paper we give a practical overview of the changes in the financing of health care in Hungary. We describe the financing system of general practitioners, home care (nursing), out-patient care and the acute and chronic care of hospitals. We show how the financial system has changed after the political changes of 1990. The global budget approach of the 1980s was replaced by performance-related financing methods including the ICPM (International Classification of Procedures in Medicine) code system of the WHO (World Health Organization) in out-patient care and the introduction of HBCS (Homogén Betegségcsoportok, “Homogeneous Disease Groups”) in in-patient care. We underline that the efforts made towards reforming health care financing resulted in an activity-related financing system.

The effect of an organized, nationwide breast cancer screening programme on non-organized mammography activities

Objectives To analyse the effect of an organized, nationwide breast cancer screening programme on non-organized mammography activities in Hungary. Setting The nationwide dataset of the Hungarian National Health Insurance Fund Administration covering the years 2000-2005. Methods Data derived from the nationwide database of the Hungarian National Health Insurance Fund Administration. The study includes all women undergoing mammography before (2000-2001) and after (2002-2003/2004-2005) the introduction of organized screening. Results The number of women having non-organized (opportunistic/diagnostic) mammograms was around 250,000 in 2000-2001, but increased to 350,000 in 2005. In the age group 45-64 years in 2000-2001, only 27.4% of all women undergoing mammography were examined within locally-organized programmes. After the introduction of the nationwide programme, this percentage increased to 61.0% in 2002-2003, and 56.3% in 2004-2005. After the introduction of the nationwide organized programme (2002-2003), the proportion of organized screening mammographics remained among the highest in county Hajdú-Bihar (78.4%) and Zala (88.3%) and increased significantly in county Vas (87.7%). Conclusion The introduction of an organized nationwide screening programme in Hungary resulted in increases in the number of screening mammographics, and also of non-organized mammographics. Although the ratio of organized screening versus non-organized mammography changed in favour of screening mammographics, there are large within-country differences between counties.

Development of health economics in Hungary between 1990-2006

cz1,2 · Csa ba Dózsa3 · Zoltán Kaló4 · Lás zló Nagy5 · Bar bara Borc sek3 · Ágnes Brandt müller6 · József Betle hem7 · An dor Sebestyén8 · Lás zló Gulác si6 1 De part ment of Health Pol i cy, Na tion al Health In sur ance Fund Ad min is tra tion (OEP), Bu dapest, Hun gary 2 In sti tute of Di ag nos tics and Man age ment, Fac ul ty of Health Sci ences, Uni ver si ty of Pécs, Pécs, Hun gary 3 Min istry of Health, Bu dapest, Hun gary 4 No var tis, Bu dapest, Hun gary 5 MSD, Bu dapest, Hun gary 6 De part ment of Pub lic Pol i cy and Man age ment, Unit of Health Eco nomics and Health Tech nol o gy As sess ment, Corv i nus Uni ver si ty Bu dapest, Hun gary 7 In sti tute of Nurs ing and Clin i cal Sci ences, Fac ul ty of Health Sci ences, Uni ver si ty of Pécs, Pécs, Hun gary 8 Coun ty Baranya Health In sur ance Fund Ad min is tra tion, Pécs, Hun gary

[Correlation between risk factors and mortality in elderly patients with femoral neck fracture with 5-year follow-up].

UNLABELLED Hip fractures are associated with increased mortality in the elderly. There are only a few studies based on large patient number covering a nationwide health care system. AIM The aim of this study was to investigate the mortality following primary treatment in patients over 60 with acute, monotraumatic femoral neck fracture on monthly and annual base during a 5-year follow-up period; and to evaluate the effect of different risk factors on mortality during the follow-up. METHODS Data were derived from the nationwide database of the National Health Insurance Fund Administration. The evaluation includes patients with femoral neck fracture discharged from inpatient care institutions in 2000 following a primary surgical treatment. Weekly, monthly and annual mortality rates, and its monthly and annual trends according to risk factors were calculated. Logistic and Cox regression analysis was performed to evaluate the correlation between risk factors and mortality. RESULTS 3783 patients were involved in the study with a mean age of 77,97 years (SD 8,52). The mortality rates were 1,71% (during the first week), 8,99% (30 days), 30,74% (first year) and 61,88% (in 5 years). Mortality showed a declining trend up to the 5th month, and is stagnant after the first year. Risk factor analysis showed that higher risk of mortality is associated with male sex and higher age group up to 5 years, co-morbidities up to 4 years, lateral type femoral neck fracture and 12 hours delay of primary treatment up to 2 years, early local complications up to 1 year and surgical treatment during week-end up to 1 month. Surgical treatment delivered in national health institutes and university clinics resulted in a lower mortality risk up to 1 year. CONCLUSIONS In order to reduce mortality during the management of hip fractures, the authors emphasize the importance of delay of treatment within 12 hours, appropriate selection of methods corresponding to fracture type, providing the same conditions for primary treatment during all days of the week, to organize the treatment to special centres, appropriate acute care and follow-up corresponding to the general health status and co-morbidities of patients.Evaluation of the correlation between risk factors and mortality in elderly patients with femoral neck fracture with 5-year follow-up. Hip fractures are associated with increased mortality in the elderly. There are only a few studies based onlargepatientnumbercoveringanationwidehealthcaresystem.Aim:Theaimofthisstudywastoinvestigatethemor tality following primary treatment in patients over 60 with acute, monotraumatic femoral neck fracture on monthly and annual base during a 5-year follow-up period; and to evaluate the effect of different risk factors on mortality during the follow-up. Methods: Data were derived from the nationwide database of the National Health Insurance Fund Administration. The evaluation includes patients with femoral neck fracture discharged from inpatient care institutions in 2000 following a primary surgical treatment. Weekly, monthly and annual mortality rates, and its monthly and annual trendsaccordingtoriskfactorswerecalculated.LogisticandCoxregressionanalysiswasperformedtoevaluatethecorre lationbetweenriskfactorsandmortality.Results:3783patientswereinvolvedinthestudywithameanageof77,97years (SD 8,52). The mortality rates were 1,71% (during the first week), 8,99% (30 days), 30,74% (first year) and 61,88% (in 5 years). Mortality showed a declining trend up to the 5 th month, and is stagnant after the first year. Risk factor analysis showed that higher risk of mortality is associated with male sex and higher age group up to 5 years, co-morbidities up to 4 years, lateral type femoral neck fracture and 12 hours delay of primary treatment up to 2 years, early local complications up to 1 year and surgical treatment during week-end up to 1 month. Surgical treatment delivered in national health institutes and university clinics resulted in a lower mortality risk up to 1 year.Conclusions:In order to reduce mortality during the management of hip fractures, the authors emphasize the importance of delay of treatment within 12 hours, appropri

Evaluation of the correlation between risk factors and mortality in elderly patients with femoral neck fracture with 5-year follow-up

UNLABELLED Hip fractures are associated with increased mortality in the elderly. There are only a few studies based on large patient number covering a nationwide health care system. AIM The aim of this study was to investigate the mortality following primary treatment in patients over 60 with acute, monotraumatic femoral neck fracture on monthly and annual base during a 5-year follow-up period; and to evaluate the effect of different risk factors on mortality during the follow-up. METHODS Data were derived from the nationwide database of the National Health Insurance Fund Administration. The evaluation includes patients with femoral neck fracture discharged from inpatient care institutions in 2000 following a primary surgical treatment. Weekly, monthly and annual mortality rates, and its monthly and annual trends according to risk factors were calculated. Logistic and Cox regression analysis was performed to evaluate the correlation between risk factors and mortality. RESULTS 3783 patients were involved in the study with a mean age of 77,97 years (SD 8,52). The mortality rates were 1,71% (during the first week), 8,99% (30 days), 30,74% (first year) and 61,88% (in 5 years). Mortality showed a declining trend up to the 5th month, and is stagnant after the first year. Risk factor analysis showed that higher risk of mortality is associated with male sex and higher age group up to 5 years, co-morbidities up to 4 years, lateral type femoral neck fracture and 12 hours delay of primary treatment up to 2 years, early local complications up to 1 year and surgical treatment during week-end up to 1 month. Surgical treatment delivered in national health institutes and university clinics resulted in a lower mortality risk up to 1 year. CONCLUSIONS In order to reduce mortality during the management of hip fractures, the authors emphasize the importance of delay of treatment within 12 hours, appropriate selection of methods corresponding to fracture type, providing the same conditions for primary treatment during all days of the week, to organize the treatment to special centres, appropriate acute care and follow-up corresponding to the general health status and co-morbidities of patients.Evaluation of the correlation between risk factors and mortality in elderly patients with femoral neck fracture with 5-year follow-up. Hip fractures are associated with increased mortality in the elderly. There are only a few studies based onlargepatientnumbercoveringanationwidehealthcaresystem.Aim:Theaimofthisstudywastoinvestigatethemor tality following primary treatment in patients over 60 with acute, monotraumatic femoral neck fracture on monthly and annual base during a 5-year follow-up period; and to evaluate the effect of different risk factors on mortality during the follow-up. Methods: Data were derived from the nationwide database of the National Health Insurance Fund Administration. The evaluation includes patients with femoral neck fracture discharged from inpatient care institutions in 2000 following a primary surgical treatment. Weekly, monthly and annual mortality rates, and its monthly and annual trendsaccordingtoriskfactorswerecalculated.LogisticandCoxregressionanalysiswasperformedtoevaluatethecorre lationbetweenriskfactorsandmortality.Results:3783patientswereinvolvedinthestudywithameanageof77,97years (SD 8,52). The mortality rates were 1,71% (during the first week), 8,99% (30 days), 30,74% (first year) and 61,88% (in 5 years). Mortality showed a declining trend up to the 5 th month, and is stagnant after the first year. Risk factor analysis showed that higher risk of mortality is associated with male sex and higher age group up to 5 years, co-morbidities up to 4 years, lateral type femoral neck fracture and 12 hours delay of primary treatment up to 2 years, early local complications up to 1 year and surgical treatment during week-end up to 1 month. Surgical treatment delivered in national health institutes and university clinics resulted in a lower mortality risk up to 1 year.Conclusions:In order to reduce mortality during the management of hip fractures, the authors emphasize the importance of delay of treatment within 12 hours, appropri

The coverage of cervical screening in Hungary

UNLABELLED The purpose of this study is to calculate the proportion of women having cytological examination (Pap smear) of cervix either within or outside of the Hungarian organized cervical cancer screening programme. METHODS The data derive from the financial database of the National Health Insurance Fund Administration (OEP) of Hungary covering the period of 2000-2005. The period 2000-2002 was considered as a reference period of opportunistic screening, while 2003-2005 was the first screening circle of organized screening. RESULTS Between 2000-2002 1 667 618 women underwent cytological examination of Pap smear, and it increased to 1 749 498 women between 2003-2005. In the age-group 25-64 years, the annual coverage varied between 22.0-23.3% in 2000-2002, and it increased to 23.4-24.3% between 2003-2005. In the target population the 3-years-coverage increased from 48.9% in 2000-2002 to 52.6% in 2003-2005 (+3.7%). CONCLUSIONS The organized screening programme managed to increase moderately the coverage of target population. In order to realize the mortality decline due to cervical cancer, participation rate must be increased.

The Hungarian Care Managing Organization Pilot Program

OBJECTIVES The 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. METHODS After 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. RESULTS The 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. CONCLUSIONS We can conclude that this pilot had a significant contribution to the modernization of the Hungarian health care system.

Utilization of physiotherapy services in case of trauma disorders of the lower extremity in the outpatient care

Bevezetes: Az also vegtagi serulesek ellatasanak orvosi aspektusai jol dokumentaltak, azonban keves informacioval rendelkezunk e korkepek fizioterapias ellatasarol. Celkitűzes: A szerzők az also vegtag seruleseihez kapcsolodo fizioterapias jellegű tevekenysegek igenybeveteli mutatoinak elemzeset tűztek ki celul eletkor es nemek szerinti bontasban a jarobeteg-szakellatasokban. Modszer: Az Orszagos Egeszsegbiztositasi Penztar adatbazisabol a 2009-ben tortenő jarobeteg-ellatasokbol az alsovegtag-serulesekhez kapcsolodo fizioterapias tevekenysegek esetszamait elemeztek. Eredmenyek: 2009-ben az also vegtag seruleseit kovető fizioterapias tevekenysegek 10 000 főre juto atlagos esetszam a ferfi es a női nemnel „a csipő es a comb serulesei” csoportban 249,75 es 443,7, „a terd es a labszar serulesei” csoportban 927,64 es 668,25, „a boka es a lab serulesei” csoportban 307,58 es 245,75 volt. Az also vegtag seruleseinel mindharom regio vonatkozasaban megallapithato volt, hogy a 15–49 ev kozotti korosztalyban a ferfiak esetszamai, mig idősebb korban a nők ertekei voltak magasabbak. Kovetkeztetesek: A tanulmany alapjan az alsovegtag-serulesek kezeleseben a fizioterapias tevekenysegek szama jelentős, nemek kozotti eltereseket mutatott. Orv. Hetil., 2013, 154, 985–992. | Introduction: Limited information is available on physiotherapy treatment of lower extremity injuries. Aim: The purpose of this study included analysis of the utilization of outpatient physiotherapy services in case of injuries of the lower extremity. Method: Data derived from the database of the National Health Insurance Fund Administration, Hungary. The number of cases undergoing physiotherapy activities after lower extremity injuries were determined. Results: In 2009 the average number of cases undergoing physiotherapy activities following lower extremity injuries per 10,000 persons were the following: „hip and thigh injuries” 249.75 male cases and 443.7 female cases; „knee and leg injuries” 927.64 male cases and 668.25 female cases, and „ankle and foot injuries” 307.58 male cases and 245.75 female cases. Conclusions: According to this study, the number of physiotherapy activities for patients with injuries of the lower extremity showed significant differences between genders. Orv. Hetil., 2013, 154, 985–992.

The attendance of the second screening period (2004–2005) of the Hungarian organized breast cancer screening program

AIM Organised, nationwide screening for breast cancer with mammography in the age group of 45-65 years with a 2-year screening interval started in Hungary in January 2002. The aim of this study is to analyze the attendance rate of breast screening programme, including the analysis of the ratio of screening and diagnostic mammography examinations. DATA AND METHODS The data derive from the financial database of the National Health Insurance Fund Administration (NHIFA) covering the 6-year period between 2000-2006. The ratio of women in the age group of 45-65 years was calculated having either a screening mammography or a diagnostic mammography. The analysis was carried out for the years 2000-2001 before and 2002-2003, 2004-2005 after the implementation of nationwide organised programme. RESULTS In the years 2000-2001 7.26% of the women aged 45-65 had an opportunistic screening mammography, while in 2002-2003 34% and in 2004-2005 29.5% of the target population had screening mammography within the organised programme. During the same periods 19.8% (2000-2001), 22.1% (2002-2003) and 23.2% (2004-2005) of women aged 45-65 had a diagnostic mammography. Thus the total (screening and diagnostic) coverage of mammography increased from 26.2% (2000-2001) to 53.5% (2002-2003) and 50.8% (2004-2005). CONCLUSIONS Attendance of the Hungarian organised breast cancer screening programme slightly declined in 2004-2005, and to achieve the expected results in decline of mortality further improvement of attendance is necessary.