B. Molics

Multicriteria decision analysis in the reimbursement of new medical technologies: real-world experiences from Hungary.

We read with great interest the excellent article of Sussex et al. [1] on a pilot study of multicriteria decision analysis (MCDA) for valuing orphan medicines. MCDA seems to be more important in the past years, and many countries have tried to use it for evaluating new medical technologies [2,3]. We would like to give a short overview on the application of MCDA in Hungary. Hungary can be considered an upper-middle–income country [4]. We run a solidarity-based health insurance system with a single payer, where the National Health Insurance Fund Administration (in Hungarian: Országos Egészségbiztosítási Pénztár [OEP]) is the only health care financing agency [5,6]. All the hospitals—with the exception of church hospitals—are owned by the central government. On behalf of the central government, a governmental public agency, the National Institute for Qualityand Organizational Development in Healthcare and Medicines (in Hungarian: Gyógyszerészeti és Egészségügyi Minőségés Szervezetfejlesztési Intézet [GYEMSZI]) is responsible for the supervision of Hungarian hospitals [7]. The Hungarian health technology assessment (HTA) Office was established in 2004, and it also belongs to GYEMSZI [8,9]. Hungary adopted the directive 89/105/EEC of the Council of the European Communities on transparency for the evaluation of new drugs (2004) and medical devices (2007) applying for health insurance reimbursement [10]. We also have a formal guideline for conducting economic evaluation of health care interventions in Hungary [11]. More detailed description of the Hungarian health care system can be found elsewhere [12–17]. MDCA was introduced in Hungary by a ministerial decree in 2010 for the evaluation of new hospital medical technologies applied in hospital care [18]. In this term, medical technologies do include neither drugs nor medical devices. As a part of the application dossier, one must submit a formal HTA report (including a health-economics analysis), clinical evaluation, clinical expert opinion, and detailed cost calculation. Detailed cost calculation should demonstrate how the new hospital medical technology complies with the special financing methods of the Hungarian hospital care. It means that beyond the cost of new technology, its additional costs (e.g., implantation surgery, hospital stay, and nursing care) must be calculated according to the diagnosis-related groups such as hospital care financing [19,20]. The key players of the decision-making process are the health care financing agency (OEP), HTA office (within GYMESZI), Hungarian Medical College, and Scientific Council in Health Care.

The effect of performance-volume limit on the DRG based acute care hospital financing in Hungary

OBJECTIVES The aim of our paper is to analyse the effect of the so-called performance volume limit (PVL) financing method on acute hospital care. DATA AND METHODS The data were derived from the nationwide administrative dataset of the National Health Insurance Fund Administration (OEP) covering the period 2003-2008. We analysed the trends in the DRG cost-weights, number of cases, case-mix, and average length of stay. We calculated the average annual reimbursement rate per DRG cost-weight with and without the application of PVL degression according to the hospital type and medical professions. RESULTS Our results showed that although the national case mix (i.e., the sum of all of the DRG cost-weights produced in one year) did not change between 2003-2006, the trend of the annual number of cases increased, and the average length of stay decreased. During 2007-2008, a significant decline was found in each indicator. The introduction of the PVL resulted in a health insurance budget saving of 1.9% in 2004, 2.6% in 2005, 3.4% in 2006, 5.6% in 2007, and 3.2% in 2008. We found the lowest reimbursement rate per DRG cost-weight at the university medical schools (HUF 138,200 or € 550) and childrens hospitals (HUF 132,547 or € 528), whereas the highest was at the county hospitals (HUF 143,451 or € 571) and city hospitals (HUF 142, 082 or € 565). CONCLUSIONS The implementation of the PVL reduced the acute care hospital activity and reimbursement. The effect of the PVL was different on the different types of hospitals, and it had a serious disadvantageous effect on the university medical schools and childrens hospitals.

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.

FIT performance in early-stage colorectal cancer-letter

See the Response, [p. 1563][1] We read with great interest the excellent article of Droste and colleagues on the assessment of the effect of higher cutoff levels of quantitative fecal immunochemical tests (FIT) on test positivity rate and detection rate of early-stage colorectal cancers (CRC; ref

Az otthoni szakápolás egészségbiztosí tási vonatkozásainak elemzése Magyarországon

Bevezetes: Az otthoni szakapolas 1996 vegen indult meg Magyarorszagon. Celkitűzes: A szerzők celja a magyar otthoni szakapolasi rendszer egeszsegbiztositasi es igenybeveteli mutatoinak bemutatasa. Modszer: Az elemzesben szereplő adatok az Orszagos Egeszsegbiztositasi Penztar finanszirozasi adatbazisabol (2001–2012) szarmaznak. Elemeztek a betegszamokat, a vizitszamokat, a szakapolasi es szakiranyu terapias tevekenysegek (gyogytorna, fizioterapia, logopedia) aranyat. Eredmenyek: Az ellatott betegek szama a 2001. evi 36 560-rol 2012-re 51 647-re nőtt, 41,3%-kal emelkedett. A teljesitett vizitek szama ugyanezen időszak alatt 841 715-ről 1 194 670-re, 41,9%-kal nőtt. A szakapolasi es szakiranyu terapias tevekenysegek, valamint az apolasi fokozatok vonatkozasaban jelentős megyek kozotti eltereseket figyeltek meg. A szakapolasra kifizetett osszegek aranya a legmagasabb volt Nograd (80,4%), Szabolcs-Szatmar-Bereg (79,7%) es Komarom-Esztergom (74,6%) megyekben, mig a legalacsonyabb Zala (53,0%) es Csongrad (52,7%...INTRODUCTION Home nursing care was introduced in Hungary in 1996. AIM The aim of this study was to analyse health insurance data and utilization indicators of the Hungarian home nursing care. METHOD Data derived from the database of the National Health Insurance Fund Administration (2001-2012). The number of patients and visits, and the ratio of special nursing and special therapy (physiotherapy, speech therapy) were analysed. RESULTS The number of patients increased by 41.3% from 36.560 (2001) to 51.647 (2012). The number of visits also increased by 41.9% from 841.715 (2011) to 1.194.670 (2012). Significant geographical inequalities were found in the ratio of special nursing and special therapy as well as nursing needs. The ratio of reimbursement for special nursing was the highest in county Nógrád (80.4%), Szabolcs-Szatmár-Bereg (79.7%) and Komárom-Esztergom (74.6%), while the lowest in county Zala (53.0%), Csongrád (52.7%) and Budapest (47.9%). CONCLUSIONS There are significant inequalities in the home nursing care in Hungary. In order to decrease these inequalities, specific guidelines should be developed for home nursing care.

Health insurance data analysis on home nursing care in Hungary

Bevezetes: Az otthoni szakapolas 1996 vegen indult meg Magyarorszagon. Celkitűzes: A szerzők celja a magyar otthoni szakapolasi rendszer egeszsegbiztositasi es igenybeveteli mutatoinak bemutatasa. Modszer: Az elemzesben szereplő adatok az Orszagos Egeszsegbiztositasi Penztar finanszirozasi adatbazisabol (2001–2012) szarmaznak. Elemeztek a betegszamokat, a vizitszamokat, a szakapolasi es szakiranyu terapias tevekenysegek (gyogytorna, fizioterapia, logopedia) aranyat. Eredmenyek: Az ellatott betegek szama a 2001. evi 36 560-rol 2012-re 51 647-re nőtt, 41,3%-kal emelkedett. A teljesitett vizitek szama ugyanezen időszak alatt 841 715-ről 1 194 670-re, 41,9%-kal nőtt. A szakapolasi es szakiranyu terapias tevekenysegek, valamint az apolasi fokozatok vonatkozasaban jelentős megyek kozotti eltereseket figyeltek meg. A szakapolasra kifizetett osszegek aranya a legmagasabb volt Nograd (80,4%), Szabolcs-Szatmar-Bereg (79,7%) es Komarom-Esztergom (74,6%) megyekben, mig a legalacsonyabb Zala (53,0%) es Csongrad (52,7%...INTRODUCTION Home nursing care was introduced in Hungary in 1996. AIM The aim of this study was to analyse health insurance data and utilization indicators of the Hungarian home nursing care. METHOD Data derived from the database of the National Health Insurance Fund Administration (2001-2012). The number of patients and visits, and the ratio of special nursing and special therapy (physiotherapy, speech therapy) were analysed. RESULTS The number of patients increased by 41.3% from 36.560 (2001) to 51.647 (2012). The number of visits also increased by 41.9% from 841.715 (2011) to 1.194.670 (2012). Significant geographical inequalities were found in the ratio of special nursing and special therapy as well as nursing needs. The ratio of reimbursement for special nursing was the highest in county Nógrád (80.4%), Szabolcs-Szatmár-Bereg (79.7%) and Komárom-Esztergom (74.6%), while the lowest in county Zala (53.0%), Csongrád (52.7%) and Budapest (47.9%). CONCLUSIONS There are significant inequalities in the home nursing care in Hungary. In order to decrease these inequalities, specific guidelines should be developed for home nursing care.

Utilization of physiotherapy services for traumatic disorders of the lower extremity in ambulatory 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.

Elhízott populációra jellemző talpnyomásminták vizsgálata

Absztrakt Bevezetes: A testsulynak jelentős szerepe van a lab megnovekedett terheleseben es a nyomasmintak valtozasaiban, de a valtozasok eloszlasa pontosan nem ismert. Celkitűzes: Jelen kutatas celja volt normal es koros testtomegindexű egyenek talpnyomasmintainak vizsgalata, hogy kozelebbi kepet kapjunk a regionalis plantaris terheles valtozasairol. Modszer: A vizsgalatnak 180 alanya volt, a talpnyomas merese dinamikus pedobarograffal tortent. A talp 8 anatomiai regiojat vizsgaltuk, az alabbi parameterek fuggvenyeben: kontakt terulet, csucsnyomas, maximalis erő. Eredmenyek: A lab kozepső teruleten es metatarsusok alatt jelentősen nagyobb csucsnyomas jellemző az elhizott egyenekre (p<0,001). A maximalis erőertekek az ujjaknal alacsonyabb (p<0,001), a kontakt terulet adatai a totalis talpteruleten (p<0,001) es a kozepső talp teruleten szignifikansan nagyobb ertekeket mutatott az elhizottak csoportjaban (p<0,001). Kovetkeztetesek: Elhizas hatasara koros mertekű terhelesnovekedes kovetkezik be a lab kozepső...

Az otthoni szakápolás egészségbiztosítási vonatkozásainak elemzése Magyarországon@@@Health insurance data analysis on home nursing care in Hungary

Bevezetes: Az otthoni szakapolas 1996 vegen indult meg Magyarorszagon. Celkitűzes: A szerzők celja a magyar otthoni szakapolasi rendszer egeszsegbiztositasi es igenybeveteli mutatoinak bemutatasa. Modszer: Az elemzesben szereplő adatok az Orszagos Egeszsegbiztositasi Penztar finanszirozasi adatbazisabol (2001–2012) szarmaznak. Elemeztek a betegszamokat, a vizitszamokat, a szakapolasi es szakiranyu terapias tevekenysegek (gyogytorna, fizioterapia, logopedia) aranyat. Eredmenyek: Az ellatott betegek szama a 2001. evi 36 560-rol 2012-re 51 647-re nőtt, 41,3%-kal emelkedett. A teljesitett vizitek szama ugyanezen időszak alatt 841 715-ről 1 194 670-re, 41,9%-kal nőtt. A szakapolasi es szakiranyu terapias tevekenysegek, valamint az apolasi fokozatok vonatkozasaban jelentős megyek kozotti eltereseket figyeltek meg. A szakapolasra kifizetett osszegek aranya a legmagasabb volt Nograd (80,4%), Szabolcs-Szatmar-Bereg (79,7%) es Komarom-Esztergom (74,6%) megyekben, mig a legalacsonyabb Zala (53,0%) es Csongrad (52,7%...INTRODUCTION Home nursing care was introduced in Hungary in 1996. AIM The aim of this study was to analyse health insurance data and utilization indicators of the Hungarian home nursing care. METHOD Data derived from the database of the National Health Insurance Fund Administration (2001-2012). The number of patients and visits, and the ratio of special nursing and special therapy (physiotherapy, speech therapy) were analysed. RESULTS The number of patients increased by 41.3% from 36.560 (2001) to 51.647 (2012). The number of visits also increased by 41.9% from 841.715 (2011) to 1.194.670 (2012). Significant geographical inequalities were found in the ratio of special nursing and special therapy as well as nursing needs. The ratio of reimbursement for special nursing was the highest in county Nógrád (80.4%), Szabolcs-Szatmár-Bereg (79.7%) and Komárom-Esztergom (74.6%), while the lowest in county Zala (53.0%), Csongrád (52.7%) and Budapest (47.9%). CONCLUSIONS There are significant inequalities in the home nursing care in Hungary. In order to decrease these inequalities, specific guidelines should be developed for home nursing care.

A fizioterápiás jellegu tevékenységek igénybevételi mutatói a járóbeteg- szakellátásban az alsó végtag traumatológiai kórképei esetében

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.