Hungary – Preparing For The Health Care Future · 2014-06-11 · • Hungary is a target country...

Hungary – Preparing For The Health Care Future

Challenges in the changing hospital and healthcare environment

QUALITY FIRSTQUALITÄT ZUERSTKVALITÉT FÖRST

CALIDAD PRIMEROELSÖ A MINÖSÉG

MagyarországHUNGARY

Topics

• Introducing Hungary and ourselfs• The Hungarian health care system• National standard Quality System (MEES)• Good Practices• Potential improvements• Conclusions

Hungary

• Population: 10 million• Population growth: ‐0.2 %• Unemployment: 10.9 %• Life expectancy:

• 71 years Male• 79 years  Female

• Expend on Health: 5% GDP (OECD 2013). 

Participants HOPE Hungary

• Francisca Atienzar, Manager IT Helpdesk, Spain (Budapest‐Uzsoki)

• Christina Ceder, Manager in Primary Health care, Sweden (Veszprém)

• Heinrich Vymetal, IT‐Manager, Projekt‐Manager, Austria (Szeged)

• Maria Luisa Merino, Manager in Primary Health care, Spain (Budapest‐Heim Pál Childrens Hospital)

The Hungarian Health Care SystemPlayers

Patient

IntegratedOutpatient Care

Inpatient CareAcute/Chronical

Primary Care

Local OwnersMinistery

OEP

GYEMSZI

OBDK

Ministry• Healthcare belongs to the Ministry of Human Ressources• It is one out of eight Ministries• Controls the independent authorities (GYEMSZI, OEP, OBDK)  

of the HC System• Responsible for laws, strategy and HC‐planing:

– The health provision system is charactized by special health market regulation

– Patients have a constitutional‐guaranteed right to access the health sevices relatively with free way: patients are free to chose GP, ambulantory care units, hospitals in urgent cases, …

– Territorial supply obligation: special arrangement

Legal Framework ‐ Examples

• Government Decree 1208/2011. (28. Jun., 2011.) on governmental role and responsibility in health care services

• Government Decree 325/2011. (28. Dec., 2011.) on new health careregions

• XXXVIII. Act (24. May, 2012) on the governmental over taking of inpatientand outpatient specialist care institutions managed by municipalgovernments

• Government Decree 92/2012. (27. Apr., 2012) on the detailed rules of thenationalization of the specialist health care providers

• Government Decree 46/2012. (28. Mar., 2012) on centralized drug,medical equipment and desinfectant procurement

The Semmelweis Plan (4th Nov., 2010.)Whitepaper for public policy discussions on the Hungarian health government’s key objectives and related action plans

Concluded HC policy principles:• The Hungarian constitution guarantees the right to a healthy environment, 

to an optimal level of physical and mental health • Health care service has to be provided on a level where it can be delivered 

with the highest possible efficiency and quality• Hungary has a tax‐funded universal healthcare system• Hungary is a target country for cross‐border health care (Dental, SPA, 

Plastic Surgery)• Centralize the medical specialities requiring the most specific resources

Reproducethe system’s conformity: regionalplanning

Reproducethe system’s conformity: regionalplanning

Enhancementof efficiencyEnhancementof efficiency

Improvementof access

Improvementof access

Cooperationbetween the

players

Cooperationbetween the

players

GYEMSZI ‐ ResponsibilityGyógyszerészeti és Egészségügyi Minőség‐ és Szervezetfejlesztési Intézet

National Institute for Quality‐ and Organizational Development in Healthcare and Medicines

Institute for the governance and institutional supervision of state‐owned and managed healthcare system

The goal is to ensure financial sustainability & reduce geographicaldifferencies in access via:

• Promoting the functional cooperation of different health careinstitutions

• Establishing regional health care planning and management in 8regional geographical areas for 1‐1.6 million inhabitant units

• Establishing the National Center for Patient Right andDocumentation as a single‐point of contact to report malpracticeissues and ensure patient rights

• Improvement of the HR situation of the institutions

GYEMSZI ‐ Regionalized HC ManagementGyógyszerészeti és Egészségügyi Minőség‐ és Szervezetfejlesztési Intézet

National Institute for Quality‐ and Organizational Development in Healthcare and Medicines

Basic principle for regionalized HC‐management:– simpler services should be available close to patients’ place of

residence– complex, specialized interventions and services should be

provided in centers of high professional levelConsiderations:– Respect the county lines (where possible)– Define a region from an area where patient migration is low 

(under 10%)

GYEMSZI ‐ New ClassificationsGyógyszerészeti és Egészségügyi Minőség‐ és Szervezetfejlesztési Intézet

National Institute for Quality‐ and Organizational Development in Healthcare and Medicines

HC Providers• General care regional centre (4 out of 8 are university 

hospitals• Regional co‐centre• Major acute hospital• Community hospital, community health centre/day care 

hospitalSpecialised care• National institute• Specialised hospital• Nursing centre

Map of Regionalized HC Management

Western TransdanubiaPopulation: 1 354 682 (14%)Number of acut beds: 5025 Number of LTC beds: 4957

Southern TransdanubiaPopulation: 937 174 (9%)Number of acut beds : 4047Number of LTC beds : 2790

Western Central HungaryPopulation: 1 117 808 (11%)Number of acut beds : 5186Number of LTC beds : 3358

Southern Central HungaryPopulation: 1 506 509 (15%)Number of acut beds : 7623Number of LTC beds : 3791

Northern Central HungaryPopulation: 1 636 237 (16%)Number of acut beds : 5789Number of LTC beds : 4913

Southern Great PlainPopulation: 1 366 794 (14%)Number of acut beds : 5674Number of LTC beds : 2909

Northern Great PlainPopulation: 1 190 594 (12%)Number of acut beds : 5207Number of LTC beds : 2442

Northern HungaryPopulation : 852 924 (9%)Number of acut beds : 3715Number of LTC beds : 2256

OEP ‐ ResponsibilityOrszágos Egészségbiztosítási PénztárNational Hospital Insurance Fund

• Regulating the healthcare market– to increase the purchasing power– to maximize the health gain– to keep the budget– to ensure effectiveness, equity and quality

• Several purchasers (patient’s, providers intending to others for services, health insurance funds, etc.) and different responsibilities in purchasing which must be coordinated

• Managing  the fund• Paying operational costs (350.000.000 items p.a.)• Dual financing system in terms of payers: 

– operational cost covered by OEP– investment cost must be covered by state budget and  owners (local 

governments, etc.)

OEP – Quality IssuesOrszágos Egészségbiztosítási PénztárNational Hospital Insurance Fund

• Define minimal requirement system to guarantee proper quality• Define competence Levels –

– Licensing of HC‐professionals (checkup every 5 years, education and post graduateeducation)

– Licensing of new technologies and drugs (~ 500 p.a.)– Contracting with HC‐providers (~20.000 contracts)

• Different HC‐provider Levels ‐ different payment– Primary Care (per patient basis + supplements + quality parameters)– Outpatient Care (per service points)– Acute Hospital (DRG based System / HBC=Homogén Betegségcsoportok)– Chronic Hospital (per day + modifications)

• Assessments and controlling of quality indicators• Remarkable

– Penalty system (e.g. wainting list)– Very few DRGs (Rehabilitation, Chemotherapy, some expensive drugs or equipment, 

implants)  are only paid if protocols (clinical pathways) are obayed– Informations, statistics are published (www.oep.hu) 

OBDKOrszágos Betegjogi, Ellátottjogi, Gyermekjogi és Dokumentációs Központ

National Center for Patient Rights & Documentation

• established on the 1st of November 2012 by Government Decree 214/2012. (VII. 30.)

• is the central office for legal protection of patients, children, and recipients/residents of social care

• was established to fulfill the philosophies of Semmelweis plan, supported by the Government that gives a new direction to the national public health.

The tasks of the office• Legal protection• Handling of information and documentation• handling complaints in a system• Methodological tasks• International relations, cross‐border health care responsibilities• National contact point for cross‐border healthcare in the EU• Register of official records

OBDK‐Methods usedOrszágos Betegjogi, Ellátottjogi, Gyermekjogi és Dokumentációs Központ

National Center for Patient Rights & Documentation

• Levels of legal protection: 63 legal representatives nationally – 25 for patients– 20 for residents in social care– 18 for children

• Central office for complaints (registered calls since March 2013 are over 1.500)• Designing a consultant system: in the center of OBDK, consultant work in each

field of profession• OBDK representatives in every hospital and outpatient environment (employees or

volunteers)• Regional centres• Training: 181 patients’ rights representative have acquired a certificate on the

trainings organized by OBDK in 2013• Introduction of an official record: register of legal representatives for the institutes

and citizens• Documentation the work of the legal representatives: reporting system; results:

more reliable picture on the work of legal representatives and statistics• Networking, Building relationships, co‐operation with: ombudsman, Equal

Treatment Authority, Universities (Budapest, Miskolc, Debrecen Pécs, Szeged),Hospital Association, Hungarian Chamber of Pharmaceutics

OBDK – New PossibilityOrszágos Betegjogi, Ellátottjogi, Gyermekjogi és Dokumentációs Központ

National Center for Patient Rights & Documentation

From 1st of January 2014, the OBDK may act ex‐offico or on demandof a supervisory body if the case• may seriously affect the patients rights of a larger group of patients• or it is related to the access to health services, organization of care,

the referral policy or informing the patients

The possibilities of OBDK:• May ask for information from the provider, or healthcare

administrative body• May propose an action or initiate legislative amendments• May have a Recommendation: the concerned authority is obliged to

inform the OBDK about its observations regarding therecommendation within 60 days

ISO 9001

The ISO 9001 standard is based on eight quality management principles: • Customer‐oriented organization• Leadership• Participation of staff• Process‐based approach• System analysis• Continuous improvement• Evidence‐based decision‐making• Mutually beneficial supplier relationships

MEES Hungarian Health Care Standards

The MEES is the collection of the Hungarian Health Care Standards, which is actually adapted to the requirements of ISO 9001. It includes 6 main groups: • General Practice Medical Services (HES) • Inpatient Services (KES) • Outpatient Services (JES) • Women's Protective Services (VES) • General diagnostic procedures • General management and support processe

MEESInpatient Services (KES)

Take care of the patients in need as soon as possible as effective as possible and heal the patient or in case of chronic illness to alleviate the symptoms and stabilize the patient's condition. • Ensure during the health services the continuity of care• Meet the patient's expectations, to coordinate the services• Provide the correct information• Determining activities in the patient care are as follows: 

– Designing and implementation of each patient's care– Observation of the treatment and evaluate the results ‐Modify if 

needed – Regularly follow‐up 

MEESOutpatient Services (JES)

Checking in and out, making an appointment, the registration procedure and the patient's identification is done according by the regulations of the hospitalThe patient will be informed by a special trained person about the

1. admission2. how that particular institution works3. waiting lists4. how to make an appointment5. the required medical documentation and records

Every step of the health service is professionally regulated according to the professional guidelines and clinical protocols (not only the first visit, but how to make a diagnostic plan,how the diagnosis is established....etc).

MEESGeneral diagnostic procedures

Basic processes in an effective diagnostic procedure are: • Adequate information to the patient • Carrying out the diagnostic tests according to the 

physicians plan • Proper collection of the specimen needed (handling, 

transport, storage and identification of samples sent for testing) 

• After the professional examinations by the qualified personnel, evaluation of the results 

• Sending back the results to the doctor ASAP • Medical equipment, supplies...

MEESGeneral management and support processes

Patient rights, information and data management (BTA) Quality management and evaluation (MIN) Leadership (CONTROL) Human Resource Management (HEM) Resource management, Buildings, Safety Equipment (more) 

Good practice examples I

• In Balatonfüred they started a project for the citizen in 58 units all over the country

• Goal: Prevention of Cardiovascular Diseases• Preventive healthcare for people from 15‐65 years old

• Free of charge• They are meassuring (BMI, Fat‐Percentage, Blood Pressure, Chol. ...  ) and do follow‐ups

• They have all kind of group activities, individual checkups and, individual programs

• There is a cooperation with the local GP´s

Good practice examples I

• In Veszprém Questionarys are given out at least once a year to in‐patient, out‐patient, employees and the management in the hospital

• The answers they recieve are 90%(!)• The manager  of the departement has the responsibility to make the improvements

Good practice examples II

Good practice examples III

Uzsoki Hospital• They are messuring and do follow‐ups• Research is a vital component of the Uzsoki Hospital• Several of the doctors are well respected researchers publishing 

regularly in international journals and presenting at both domestic and international conferences

• Uzsoki Hospital is also a teaching hospital engaged in medical student’s education: – Providing clinical education to future and present doctors – Running successful residency and specialist training programs – Having several PhD students 

Good practice examples III

Uzsoki Hospital (continued)• Providing health care according to European standards 

– Commitment to enhancing excellence in patient care (EFQM)

– Keeping up with the latest technology by building up and maintaining state of the art medical equipment (new MRI) 

– Dedication to improve health awareness among patients to reduce alcohol and smoking related diseases 

– Promoting healthy lifestyle 

Marina Salud. Departamento de Salud de DeniaUzsoki Hospital

Good practice examples IV

MediVIR ‐management information system 

is an IT‐system implemented in Uzsoki Hospital• monitor and measure clinical activity• Performance‐volume limit (PVL) : keeping track of 

performance parameters and drug traffic, analysis, Pharmaceutical Sales Data

• Patient turnover, performance monitoring data: day care, bed occupancy, the number of discharged inpatients and funding

• Outpatient analysis: performance statements 

Good practice examples IVMediVIR ‐management information system (continued)• Aged diagnosis statement: Aged for diagnosis and grade 

breakdown, Confirmed diagnostic data, cost breakdown structure of DRG. 

• Queue statement analysis: Patient appointments, measuring length of stay

• Income: Hospital‐grade credit (OEP finance, own income)

• Analyzes of class / package

• National Indicator System, Topics:– General Data– Workplace Data (Bed‐per‐room, etc.)– Nosocomial Infections– Children– Oncology– Intensive Care– Cardiology– Geriatry– Human Resource

Good practice examples V

• Integrated education & training• Simulations of treatments• eHealth approaches• (Pilot‐)Projects in Telemedicine (Diabetes, Blood Pressures, …)

• Laws: non‐smoking, prevent cardial diseases• Cooperations with Universitary Institutes (Economy, Informatics, …)

Good practice examples  ..more

Potential improvements

• Reducing the information gap between the authorities/mangement and the employees

• The employees should be aware, that the are part of a qualitysystem – and how – and how much 

• The employee should – more often – be able to see and hear good examples that they are doing on the ”daily” basis

• This will improve their motivation

Potential improvements

• Save your investments• Maintain the (IT, Infrastrucure, Medical Machines, Buildings, ...) resources

• Renew wear‐out parts regulary, do not wait for new investments

• Guarantee the financing for repairs, maintanance and renew (e.g. IT or medical technical equipment 10‐20% of the investment sum)

• This will save operational costs und keep your systems running at state‐of‐the‐art

• Change your awareness in this objective

A hospital is not a Trabi, that can be repaired be means of chewinggum and a colourstick!

Conclusions

• What’s considered to be quality in 

healthcare?

• What’s done to improve quality in 

healthcare?

• ... and the Patient Relation Management?

So, what’s QUALITY??

Quality is something that can be evaluated, measured and can systematicaly improved by qualityassurance, aiming highest possible efficiency and quality.• independent of regional influencies• an important paramter for payment• accessible for all inhabitants and EU citizens

All HC players are responsible for quality!• Authority (awareness)• Hospital (intern and extern evaluation) & HC‐providers• Employees & Volunteers & Students (Training)• Technique & pharmacie (Licensing)• Patients (Patientrights, Empowerment, Information, Responsbility)

So, what’s done to improve it ??

• Improving structural Quality (Semmelweis Plan)

• Improving the infrastructure (Buildings, Specilized Centers)

• Managing Human Ressources (Benchmarks, raising waiges)

• Focusing the outcome (by payment)Based on a realistic, longterm plan (20 years)

... and the Patient Relationship Management??

• Detailed information (Internet, Wallpapers)• Mandatory written Point‐of‐Service Information

• Patients Rights Structure (e.g. Documentation)• Empowerment• (try to) protect the population by specific laws and campaigns (Smoking, Vaccination, Wellness,  healthy food)

Our Final Conclusions

• There is a huge difference between the new & old hospitals or departments (e.g. buildings, equipment, infrastructure, available human resources)

• Changes will take time• Changes will effect the people & culture• Hungary is on the right way • Need for patience to keep the track• Further help to improve infrastructure is needed

Thank You,for Your Attention

F r a n c i e s c aC h r i s t i n aH e i n r i c h