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

Health systems in transition Hungary 163
of chronic care, demands are systematically unmet. This is especially true for
institutional hospice care, which, according to a report of the State Audit Office
of Hungary, was not available in 75% of counties (State Audit Office, 2008b).
Patients in need of hospice care often remain in chronic care wards because
hospitals rarely establish a separate hospice ward (as they would then have to
provide hospice home care services, too) (2003/14). The capacity of alternative
providers, such as non-profit foundations, is also limited.
5.11 Mental health care
Mental health care is integrated into the main health and social care systems
both organizationally and in terms of financing. In the area of chronic
outpatient specialist care, psychiatric dispensaries provide services according
to the territorial supply obligation, both at the surgery and at the patient’s home.
In 2008 there were 140 psychiatric, 35 youth and child psychiatric and 111
addictology dispensaries in Hungary. The patient turnover was 112.1, 10.2 and
9.4 per 1000 inhabitants, of which 41.0%, 44.3% and 65.2% were visits by
patients already in care, respectively. The average number of consultations per
patient in care per year was 7.7 for adults and 8.2 for children and adolescents
(HCSO, 2010f).
Secondary inpatient care is divided into acute and chronic (long-term)
care, but services are also provided on a daytime hospital basis. As part of
the 2006–2007 service delivery restructuring reforms, approximately 1000
acute psychiatric beds were removed from the system, so the number of acute
psychiatric beds decreased from 3.8 to 2.9 beds per 10 000 inhabitants. Chronic
inpatient capacities, on the other hand, did not change substantially, but showed
a slight increasing trend, amounting to 5.7 beds per 10 000 population in
2009 (HCSO, 2009b). Furthermore, the National Institute of Psychiatry and
Neurology was closed down at the end of 2007. Certain parts of it were relocated
to other inpatient care providers, and a new National Centre for Psychiatry was
established within the organization of the National Centre for Healthcare Audit
and Inspection.
Act IV of 1959 on the Civil Code recognizes three categories of legal
capacity based on the scale of mental impairment: full capacity, limited capacity
and incapacity (1959/1, Articles 14–16). Mental disability can be attributed
to psychiatric conditions, intellectual disability or addiction. In the case of
limited capacity or incapacity, a legal guardian appointed by the court, controls