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

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Health systems in transition Hungary
professional minimum standards set by the Minister of State for Health (then
known as the Minister of Health) (State Audit Office, 2009a). According to the
report, the 2007 restructuring of inpatient care did not eliminate disparities
in the distribution of emergency care capacities, but the reorganization of
family doctor out-of-hours services was showing substantial progress. The
report also noted that single-handed stand-by services had been successfully
eliminated by 2006 and that 80% of family doctor out-of-hours services had
been centralized by 2008. The number of population per out-of-hours service
unit had increased from 8300 in 2004 to 28 500 in 2008. According to the
report, minimum professional standards had generally been met, although a
common emergency dispatch system with the National Emergency Ambulance
Service and the local A&E units was present in only 5% of cases (State Audit
Office, 2009a). Utilization based on payment reports showed large variations:
the proportion of actual emergencies out of 911 calls and visits to A&E units
ranged between 3% and 100%.
The report also showed that progress had been made in the development
of A&E departments, as the share of emergency cases admitted through these
departments had increased from 61% in 2006 to 78% in 2008, paralleling
a general increase in the effectiveness and efficiency of emergency care.
Nevertheless, the proportion of emergency cases using other entry points
remained (and undoubtedly still remains) high, with the distribution of
A&E capacities showing large regional disparities (that is, an almost tenfold
difference between the lowest and highest figures) in 2008. The audit of the
NPHMOS in 2008 found that only 22 out of the 45 A&E units met all the
required professional standards, with staffing shortages being the most frequent
problem (State Audit Office, 2009a).
One of the key performance indicators often emphasized by decision-makers
is the time needed to reach the site of the emergency, the target value having
been set at 15 minutes. In an evaluation of the performance of the National
Emergency Ambulance Service, Burány (2007) found that this target was
reached in only 78.5% of cases in 2006 and, despite reform efforts, had hardly
improved between 2000 and 2006 (attributable mainly to staff shortages).
Given that emergency care is still under reorganization and development
in Hungary, patient pathways, from the first contact with the health care
system to the completion of treatment and discharge, can vary to a large extent
depending on the socioeconomic status of the patient and the location where
the incident took place. Most experiences with the implementation of various
reform measures have yet to be evaluated by the State Secretariat for Healthcare.