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

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Health systems in transition Hungary
LTNC”, “LTNC: day care” and “LTNC: home care”). It is important to note,
however, that most LTNC services in Hungary are still provided on an inpatient
basis.
Capacities in inpatient LTNC are difficult to measure using the official
statistics because long-term care was not recognized as a separate category
of chronic inpatient care in Hungary until 1997. Furthermore, until 2001, all
pulmonology and psychiatry beds were considered chronic, and these specialties
are still listed as separate categories within chronic care, whereas rehabilitation
beds and beds in sanatoria were merged into a single category after 1990
(HCSO, 1998b, 2010f). Real changes in the number of chronic beds also took
place, the most substantial of which was an increase of about 7500 beds in
2007. In 2009 the number of chronic hospital beds per 10 000 inhabitants was
27, 10% of which belonged to LTNC (HCSO, 2010f). In 1997 the corresponding
numbers were 25 and 3.6% (HCSO, 1998b). In 2010 the average length of stay in
chronic wards was 27.6 days and bed occupancy was 83.6%, while in long-term
care wards they comprised 65.5 days and 86.3%, respectively. Bed occupancy
was 76.4% and average length of stay was 45.6 days for LTNC (HCSO, 1998b).
Both figures have shown a tendency to increase over the past 13 years.
The so-called daytime hospital is an emerging form of care that is mainly
used in the long-term care of psychiatric patients. Home-based nursing care,
on the other hand, is divided into two categories: (1) hospice home care and (2)
specialist home care. Hospice care (both inpatient and home-based) is discussed
in section 5.10. A decree defines the health care services that can be provided
within the category of specialist home care (Annex 1), the qualifications
required of the provider (Article 2) and the minimum infrastructure
requirements, including those related to office equipment, vehicles, medical
equipment and medical supplies (Annex 2). The providers of specialist home
care have to contract with a regional branch of the NHIFA in order to supply
services in a defined territory. Home care is paid from a separate sub-budget
of the HIF on the basis of visits (adjusted for the complexity of the case and
certain geographical factors). In 2008 a total of 366 providers were registered
and 51.8 patients per 10 000 inhabitants were served. Pressure ulcers were the
most frequent diagnosis, and special nursing and physiotherapy accounted for
94% of services provided in 2008 (NHIFA, 2009a).