I Boncz

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.

Health technology assessment in Poland, the Czech Republic, Hungary, Romania and Bulgaria

This paper describes and discusses the development and use of health technology assessment (HTA) in five Central and Eastern European countries (CEE): Poland, the Czech Republic, Hungary, Romania and Bulgaria. It provides a general snapshot of HTA policies in the selected CEE countries to date by focusing on country case-studies based on document analysis and expert opinion. It offers an overview of similarities and differences between the individual CEE countries and discusses in detail the role of HTA by assessing its formalization and institutionalization, standardization of methodology, the use of HTA in practice and the degree of professionalization of HTA in the region. It finds that HTA has been to some extent implemented in all five countries studied, with methodologies in accordance with international standards, but that challenges remain when it comes to the role of HTA in health care decision-making as well as to human resource capacities of the countries. This paper suggests that coming years will show whether CEE countries develop adequate national analytical capacity to assess and appraise technologies in the context of local need and affordability, instead of using HTA as a mere administrative procedure to fulfill (inter)national requirements. Finally, suggestions are provided to strengthen HTA in CEE countries through cooperation, mutual learning, a common accreditation of HTA bodies and increased network building among CEE HTA experts.

Capacity Building for HTA Implementation in Middle-Income Countries: The Case of Hungary

OBJECTIVES Middle-income countries often have no clear roadmap for implementation of health technology assessment (HTA) in policy decisions. Examples from high-income countries may not be relevant, as lower income countries cannot allocate so much financial and human resources for substantiating policy decisions with evidence. Therefore, HTA implementation roadmaps from other smaller-size, lower-income countries can be more relevant examples for countries with similar cultural environment and economic status. METHODS We reviewed the capacity building process for HTA implementation in Hungary with special focus on the role of ISPOR Hungary Chapter. RESULTS HTA implementation in Hungary started with capacity building at universities with the support of the World Bank in the mid 90s, followed by the publication of methodological guidelines for conducting health economic evaluations in 2002. The Hungarian Health Economics Association (META) - established in 2003 - has been recognized as a driving force of HTA implementation. META became the official regional ISPOR Chapter of Hungary in 2007. In 2004 the National Health Insurance Fund Administration made the cost-effectiveness and budget impact criteria compulsory prior to granting reimbursement to new pharmaceuticals. An Office of Health Technology Assessment was established for the critical appraisal of economic evaluations submitted by pharmaceutical manufacturers. In 2010 multicriteria decision analysis was introduced for new hospital technologies. CONCLUSION The economic crisis may create an opportunity to further strengthen the evidence base of health care decision-making in Hungary. In the forthcoming period ISPOR Hungary Chapter may play an even more crucial role in improving the standards of HTA implementation and facilitating international collaboration with other CEE countries.

Quality management and patient safety: survey results from 102 Hungarian hospitals.

OBJECTIVES The aim of this study is to describe the development of quality management systems in Hungarian hospitals. It also aims to answer the policy question, whether a separate patient safety policy should be created additional to quality policies, on national as well as hospital level. METHOD In 2005, a questionnaire survey was conducted to evaluate the existing quality management systems in all Hungarian hospitals. The relationship between the level of the development of quality management systems, the certification status and the current level of patient safety activities was investigated using linear regression. Quality was measured with the quality management system development score (QMSDS), and patient safety by the number of patient safety activities. RESULTS 102 of 134 (76%) of the hospitals have returned the questionnaire. The average hospital has 24.5 of 35 core quality activities, and 4 of 11 patient safety activities. There is a statistically significant but weak relationship between the QMSDS and the number of patient safety activities, explaining 12% of the latters variance. Certification (International Standards Organisation (ISO) and professional standard based) is not significantly related to patient safety. CONCLUSIONS In our study quality by QMSDS is weakly related; however, certification is not significantly related to patient safety. We conclude that separate patient safety policies seem worthwhile to be created for the hospital sector in addition to the ongoing quality improvement efforts in Hungary.

The occurrence of acute myocardial infarction in relation to weather conditions

The spatial and temporal changes of weather factors depend on geographical location, seasons and the time of the day. Our study examines the relationships of meteorological factors and the incidence of acute myocardial infarction (AMI). A retrospective analysis of patients diagnosed with AMI between 2000 and 2004 in Hungary (n = 81,956 patients) was carried out. Data were collected by the National Health Insurance Fund Administration (OEP) and the National Meteorology Service (OMSZ). A peak period of the occurrence of AMI was found during spring, while minimum number of events were recorded during summer. Significant difference was observed between the number of events each season (F = 34.741; p < 0.001; N = 81,956). A medium level negative correlation was found between the monthly average temperature and the occurrence of AMI (r = -0.404) during the period examined. A positive correlation was shown between front movements and the number of events per season (r = 0.053). Average barometric pressure changes, the number of front movements and the number of AMI events also showed a nearly similar seasonal deviation. Our findings show that certain meteorological factors may be related to the onset of AMI, however other factors also play an important role.

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.

Histological chorioamnionitis is associated with cerebral palsy in preterm neonates.

OBJECTIVE To determine the interaction between histological chorioamnionitis and unexplained neonatal cerebral palsy among low birth weight infants. STUDY DESIGN We studied 141 preterm infants below 1500 g delivered between 2000 and 2010. Clinical data, neonatal neuroimaging, laboratory results, the histopathological features of the placenta and gastric smear within the first hour of delivery, were evaluated. RESULTS Cerebral palsy was detected in 11 out of 141 preterm newborns (7.8%). The incidence of silent histological chorioamnionitis was 33.6% (43 of 128 cases). Chorioamniontis was significantly associated with the risk of unexplained cerebral palsy (p=0.024). There were also significant correlations between maternal genital infections and chorioamnionitis (p=0.005), and between maternal infections and a positive smear of neonatal gastric aspirates (p=0.000). The rate of cesarean section was 67.4% (95 out of 141 deliveries), and elective cesarean section was performed in 68 cases. CONCLUSION Intrauterine exposure to maternal infection was associated with a marked increase in the risk of cerebral palsy in preterm infants.

Permanent stress may be the trigger of an acute myocardial infarction on the first work-day of the week

Numerous studies have reported the weekly variation of an acute myocardial infarction. The Monday peek has been connected with higher rate of physical and mental, work-related stress. We wished to study the weekly variation of an acute myocardial infarction (AMI) in the group of workers and pensioners, and to find out whether National Holidays on the first day of the week could influence the weekly rhythm of an acute myocardial infarction. We carried out the retrospective analysis of patients admitted to Hungarian hospitals with the diagnose of an AMI (n=90,187) between 2002 and 2007. According to the morbidity data of an AMI, the weekly peek was detected on the first work-day of the week, showing a gradually decreasing tendency until the end of the week. Morbidity rates on Mondays being National Holidays were similar to the number of events on Saturdays and Sundays (Z=-24,431; p<0.001). There was a significant difference between the number of events on work-days and weekends (Z=-27,321; p<0.001). No marked difference was found between workers under the age of 65 and pensioners above the age of 65, or between the two sexes. The results of our study reveal that the occurrence of an AMI shows characteristic changes throughout the days of the week, and the first work-days of the week may be related to higher incidence of an acute myocardial infarction.

History of health technology assessment in Hungary

In Hungary, the history of the health technology assessment (HTA) dates back to 1993 when HTA and related activities started by professional initiatives. The legal background, institutionalization, and training capacities were created between 1998 and 2004. The main challenges for HTA in Hungary are partly similar to the ones in countries with a developed economy; no question it is time for cost-effectiveness. However, there are very important differences as well, that is why transferability and adaptability issues have to be considered. This article describes the characteristic features of the Hungarian healthcare system, the history and the current role of HTA, and the most important challenges.