Health Systems in Transition - Hungary - World Health Organization ...

Health systems in transition Hungary 143
The restructuring and development of emergency care have been a health
policy priority of successive governments for the past 20 years because the
system inherited from the Semashko-style health care system was somewhat
fragmented and uncoordinated. Emergency care under that system had three
different entry points: single-handed family doctors on duty, hospital night duty
and the National Emergency Ambulance Service. As the interface between
them was not ideal, complicated cases would easily end up in the wrong
department, causing treatment delays (State Audit Office, 2009a).
Development projects have targeted the infrastructure, organization and
coordination of services. Infrastructure development has been supported
by conditional and matching grants, both from local sources and from
EU structural funds. For the period from 2007 to 2013, a total of HUF 35
billion (about €1.3 million) has been allocated to various projects, including
the modernization of the ground and air ambulance services, the renewal of
emergency medical dispatch and the establishment of new (and upgrade of
existing) A&E departments. The main directions of organizational development
have been the centralization of out-of-hours services (that is, elimination of
single-handed, stand-by out-of-hours services by the end of 2006) (2005/9),
the establishment of one-stop A&E units in hospitals as a single entry point/
interface for emergency care patients, and the development of a common
dispatch service for all three local emergency care providers (Emergency
Ambulance Service, hospitals and family doctors’ out-of-hours services). The
last of these three developments, however, has progressed slowly: by 2009 only
7% of the centralized out-of-hours services had been integrated into a common
emergency dispatch service (State Audit Office, 2009a). In certain areas, the
National Emergency Ambulance Service has taken over the provision of out-ofhours
services, while in other areas such services are provided around the clock,
which has the advantage of meaning that family doctors are not interrupted
by emergency calls during regular surgery hours (State Audit Office, 2009a).
The development of emergency care services has been supported by payment
reforms as well. Bonus payments for centralization and the establishment
of common emergency dispatch services have supported the reorganization
of out-of-hours services, while the government has introduced a fixed fee
component in the payment of hospital A&E departments.
In 2009 the State Audit Office published a report on the efficiency,
accessibility and, to a certain extent, the quality of emergency care. In the
absence of a comprehensive performance measurement system, the report
focused mainly on the availability and distribution of capacities, some activity
measures and the assessment of whether emergency care providers had met the