[Changes of payment of physicians between 1998 and 2021 in Hungary]. / Az orvosok fizetésének alakulása 1998 és 2021 között hazánkban.

INTRODUCTION: The development of the medical career model is a priority issue from the point of view of safe patient care. OBJECTIVE: In our research, we aimed to examine the average monthly income of doctors employed in Hungary between 1998 and 2021, especially with regard to the significant increase in medical payment in 2021. DATA AND METHODS: Data were derived from the database of the National Directorate General for Hospitals. Doctors employed full-time in all public health institutions were included in our time-series analysis. In our institutional-level analysis, we considered all employed doctors of all public hospitals. Each healthcare institution was grouped according to the type of institution. RESULTS: The payment of full-time doctors in Hungary increased by 16.1 times between 1998 and 2021. In 2020, the payment of hospital doctors at the national level was 767 505 Ft (2186 €), while in 2021, as a result of the increase in medical income, it was 1 415 481 Ft (3948 €) (+84%). In 2021, this was 1 435 972 Ft (4005 €) in national institutes, 1 204 258 Ft (3359 €) in clinical centers, 1 397 181 Ft (3897 €) in capital hospitals, 1 520 821 Ft (4242 €) in county hospitals and 1 688 726 Ft (4710 €) in city hospitals. The difference between the highest and the lowest payment was 1.90 times in national institutes, 1.26 times in clinical centers, 1.93 times in capital hospitals, 1.47 times in county hospitals and 1.75 in city hospitals. CONCLUSION: In 2021, as a result of the increase in medical incomes, the average incomes increased significantly. We observed significant differences between the types of institutions. Orv Hetil. 2023; 164(29): 1146-1154.

Managing disabled workers due to occupational accidents in Indonesia: a case study on return to work program.

BACKGROUND: Limited research and studies prove the usefulness of case management for persons with disabilities, which helps disabled employees recover their dignity through medical vocational, and psychological rehabilitation in underdeveloped countries' Return To Work (RTW) programs. METHODS: This qualitative case study design involved semi structured interviews with case managers as the primary data source, supplemented by secondary data from BPJS Ketenagakerjaan. Data analysis utilized QDA Miner Lite and Python with ArcGIS integration for descriptive visualization. RESULTS: The RTW program of BPJS Ketenagakerjaan has already adopted ILO's fundamental suggestion, which creates two central themes: internal aspects that are essential to the RTW framework and external variables that impact RTW practice. The key themes produce six main pieces to discuss further: personal skill, personal literacy, providers, guidelines, authorities, and stakeholder support. CONCLUSION: Return to Work Program benefits companies, and the implementation of a career development service or a partnership with non-governmental organizations guarantees that disabled employees who cannot return to work with their former employers are still in the global economy.

Analysis of the Return to Work Program for Disabled Workers during the Pandemic COVID-19 Using the Quality of Life and Work Ability Index: Cross-Sectional Study.

BACKGROUND: Occupational accidents are rising, but there is little evidence on the outcomes of patients who received case management during Return to work (RTW) programs. This study examined the case management-based on RTW program features that improve the work ability index (WAI) and quality of life (QoL). METHODS: This cross-sectional research involved 230 disabled workers due to an occupational injury in Indonesia, 154 participated in RTW, and 75 did not participate in RTW (non-RTW) during the COVID-19 pandemic. Sociodemographic and occupational factors were used to examine the RTW results. We used the Finnish Institute of Occupational Health's WAI questionnaires to measure the work ability index and World Health Organization Quality of Life Brief Version (WHOQOL-BREF) for quality of life. RESULTS: The study found a statistically significant difference in working duration and preferred treatment for RTW between the groups (p-value = 0.039). Furthermore, the quality of life in the domain of environmental health and work ability index score also demonstrated a significant difference between the groups (p-value = 0.023 and 0.000, respectively). CONCLUSIONS: During the COVID-19 pandemic, this study found that the RTW program improved the quality of life and work abilities of disabled workers.

Changes in the Number of Physicians and Hospital Bed Capacity in Europe.

OBJECTIVES: Our aim was to examine the numbers of practicing physicians and total numbers of hospital beds in European Organisation for Economic Co-operation and Development countries. METHODS: Data analyzed were derived from the "Organisation for Economic Co-operation and Development Health Statistics 2020" database between 1980 and 2018. The selected countries were compared according to the type of healthcare system and geographical location by parametric and nonparametric tests. RESULTS: In 1980, Bismarck-type systems showed an average number of physicians of 2.3 persons/1000 population; in Beveridge-type systems, it was 1.7 persons. By 2018, it leveled out reaching 3.9 persons in both healthcare system types. In 1980, average physician number/1000 was 2.5 persons in Eastern Europe; in Western Europe, it was 1.9 persons. By 2018 this proportion changed with Western Europe having the higher number (3.7 persons; 3.9 persons). In 1980, average number of hospital beds/1000 population was 9.6 in Bismarck-type systems whereas in Beveridge-type systems it was 8.8. By 2018, it decreased to 5.6 in Bismarck-type systems (-42%) and to 3.1 in Beveridge-type systems (-65%). In 1980, the average number of hospital beds/1000 population in Eastern Europe was 10.3; in Western Europe, it was 8.5. By 2018, the difference between the 2 regions did not change. CONCLUSIONS: Although the number of physicians was 33% higher in 1980 in Eastern Europe than in Western Europe, by 2018 the number of physicians was 5% higher in Western Europe. In general, regardless of the healthcare system and geographical location, the proportion of physicians per 1000 population has improved due to a larger decrease in the number of hospital beds.

Nationwide epidemiological and health insurance disease burden of rheumatoid arthritis in Hungary / A rheumatoid arthritis okozta országos epidemiológiai és egészségbiztosítási betegségteher Magyarországon.

Összefoglaló. Bevezetés: A rheumatoid arthritisszel kapcsolatos szolgáltatások igénybevétele nagy teher az egészségügyi rendszerek számára. Célkituzés: Elemzésünk célja volt a rheumatoid arthritis okozta éves epidemiológiai és egészségbiztosítási betegségteher meghatározása Magyarországon. Adatok és módszerek: Az elemzésben felhasznált adatok a Nemzeti Egészségbiztosítási Alapkezelo (NEAK) finanszírozási adatbázisából származnak, és a 2018. évet fedik le. Meghatároztuk az éves betegszámokat, a prevalenciát 100 000 lakosra, továbbá az éves egészségbiztosítási kiadásokat korcsoportos és nemenkénti bontásban valamennyi egészségbiztosítási ellátás tekintetében. A rheumatoid arthritis kórképet fodiagnózisként a Betegségek Nemzetközi Osztályozása (BNO, 10. revízió) szerinti M0690-es kóddal azonosítottuk. Eredmények: Meghatározó betegforgalmat a gyógyszerek ártámogatása esetében találtunk: 7015 férfi, 23 696 no, együtt 30 711 fo. A gyógyszer-ártámogatás betegforgalmi adatai alapján a 100 000 fore eso prevalencia férfiaknál 150,2 fo, noknél 464,0 fo, együtt 314,1 fo volt. A rheumatoid arthritis kezelésére a NEAK 1,64 milliárd Ft-ot (6,07 millió USD, illetve 5,14 millió EUR) költött 2018-ban. A kiadások 19,3%-a férfiaknál, míg 80,7%-a noknél jelenik meg. A gyógyszer-ártámogatás (az összes kiadás 42,8%-a), a járóbeteg-szakellátás (21,9%) és az aktívfekvobeteg-szakellátás (12,4%) voltak a meghatározó költségelemek. Az egy betegre jutó átlagos éves egészségbiztosítási kiadás 53 375 Ft (198 USD/167 EUR) volt. Következtetés: A gyógyszerek ártámogatása bizonyult a fo költségtényezonek. A rheumatoid arthritis elofordulási gyakorisága 3,1-szer magasabb a nok esetében a férfiakhoz képest. Orv Hetil. 2021; 162(Suppl 1): 30-37. INTRODUCTION: Utilisation of services related to the treatment of rheumatoid arthritis poses a great burden for healthcare systems. Objecive: Our aim was to determine the annual epidemiological disease burden and the health insurance treatment cost of rheumatoid arthritis in Hungary. DATA AND METHODS: Data were derived from the financial database of the National Health Insurance Fund Administration (NHIFA) of Hungary, for the year 2018. The data analysed included annual patient numbers and prevalence per 100 000 population and annual health insurance treatment costs calculated for age groups and sex according to all health insurance treatment categories. Patients with rheumatoid arthritis were identified as main diagnosis with the following code of the International Classification of Diseases, 10th revision: M0690. RESULTS: We found a significant patient turnover in pharmaceutical reimbursement: 7015 men, 23 696 women, in total 30 711 patients. Based on patient numbers in pharmaceuticals, prevalence for 100 000 population among men was 150.2 patients, among women 464.0, in total 314.1 patients. In 2018, NHIFA spent 1.64 billion HUF (6.07 million USD, 5.14 million EUR) on the treatment of patients with rheumatoid arthritis. 19.3% of the costs was spent on the treatment of male, 80.7% on female patients. Pharmaceuticals (42.8% of the total expenditures), outpatient care (21.9%) and acute inpatient care (12.4%) were the main cost drivers. Average annual health insurance treatment cost per patient was 53 375 HUF (198 USD/167 EUR). CONCLUSION: Pharmaceutical reimbursement was the major cost driver. The prevalence of rheumatoid arthritis was by 3.1 higher in women compared to men. Orv Hetil. 2021; 162(Suppl 1): 30-37.

[Health policy experiences of publicly financed laboratory services in Hungary with health insurance data analysis]. / A közfinanszírozott laboratóriumi szolgáltatások egészségpolitikai tapasztalatai Magyarországon egészségbiztosítási adatok elemzésével.

Introduction: In order to provide appropriate prevention, diagnosztics, decision on therapy and monitoring the results of medical treatment, there is an increasing need for laboratory examinations. Aim: The aim of our study is the health-ecnomics analysis of laboratory budget of the Hungarian Health Insurance Fund. Data and method: Data were derived from the financial database of the National Health Insurance Fund Administration. The analysis covered the period of 2002-2018. We analysed the annual budget for laboratory examinations, the number of patients and examinations, the market share of laboratory services providers according to their owner structure from the health insurance curative-preventive budget. Results: The budget available for financing the laboratory examinations (21-22 billion Hungarian forint (Ft)/év) did not change significantly between 2005 and 2015. There was a significant decrease in the number of both patients and examinations between 2006 and 2008. In the latest years, there were 14-15 million cases per year and 180 million examinations per year. The market share of for-profit companies decreased from 29.0% in 2010 to 10.6% in 2018, while the market share of governmental institutions increased from 27.1% in 2010 to 78.7% in 2018. Conclusion: The activity of laboratories was stabilized in the latest years. After the necessary correction of professional regulations and code maintenance, the laboratory budget can be increased towards the mainly public laboratory services providers. Orv Hetil. 2020; 161(12): 468-473.

Price competition and reimbursement of biosimilar granulocyte-colony stimulating factor in Hungary.

Objectives: We analyzed the bid approach of the Hungarian National Health Insurance Fund Administration (NHIFA) based on the results of two consecutive bids on colony stimulating factor (CSF).Methods: The Hungarian NHIFA database was used to analyze the changes in the number of patients treated with CSF and reimbursement paid by NHIFA, 12 months preceding and following the bids.Results: 13,974 patients received granulocyte-CSF treatment during 12 months prior to bidding. A 4.5% decrease (13,352) and further 1.3% decrease (13,185) in the total number of patients were observed during the first and second years, respectively. The annual health insurance subsidy paid during 12 months prior to the bids was. 7.49 billion Hungarian Forint (HUF) or 26.8 million Euro (EUR). In the first year following the bid, we found a 3.3 billion HUF (12.4 million EUR) decrease in health insurance subsidy (44% reduction). A further 7.9% reduction was observed during the second year, resulting in an annual health insurance subsidy of 3.59 billion HUF (12.1 million EUR).Conclusion: During the 2 years bid (public procurement procedure), the National Health Insurance Fund Administration managed to reduce the health insurance subsidy paid for the reimbursement of both original and biosimilar G-CSF products.

[Health insurance pharmaceutical expenditures in Hungary]. / Az egészségbiztosítási gyógyszerkiadások alakulása Magyarországon.

INTRODUCTION: In Hungary, health expenditures - especially the question of health insurance subsidies for medicinal products - are becoming increasingly important. AIM: The aim of our analysis is to reveal the state's health insurance expenditure between 2010 and 2016 as well as the amount of health insurance subsidies for medicinal products. DATA AND METHODS: Data were derived from the database of the National Health Insurance Fund of Hungary and of the Hungarian Central Statistical Office. During the analysis we examined the period between 2010 and 2016. We analysed the health expenditures in proportion to the gross domestic product (GDP) as well as the changes of drug traffic based on gross consumer prices and those of health insurance subsidies, and also our regional inequalities. When writing the present study, we used descriptive statistical methods. RESULTS: The expenditures of the National Health Insurance Fund of Hungary significantly increased as proportions of the GDP from 5.5% in 2010 to 6.1% in 2016. The health insurance subsidies for medicinal products increased since 2013. The highest health insurance subsidies per 10 000 inhabitants could be seen in Baranya (405 788 HUF/inhabitant) and Csongrád (384 724 HUF/inhabitant) counties and in Budapest (377 316 HUF/inhabitant). The lowest health insurance subsidies were found in Nógrád (289 168 HUF/inhabitant) and Szabolcs-Szatmár-Bereg (271 104 HUF/inhabitant) counties. CONCLUSION: The trends of health and drug expenditure show a growing tendency. We can find significant regional inequalities in case of both the drug traffic based on gross consumer prices and the health insurance subsidies. It would be needed to strengthen the elements of prevention, and to popularize health-conscious lifestyle and doing sports. Orv Hetil. 2019; 160(Suppl 1): 49-54.

[Utilization indicators of balneotherapy in Hungary]. / A gyógyfürdoellátások igénybevételi mutatói Magyarországon.

INTRODUCTION: The role of spa therapy is well defined and its importance has significantly increased in the healthcare but the utilization indicators of the implemented treatments are less known. AIM: The objective of our study was to analyze the utilization and the social insurance indicators of the healthcare publicly financed by health insurance in spa institutions. DATA AND METHODS: The data used for the analysis were derived from the funding database of the National Health Insurance Fund of Hungary. The period examined covered the years between 2009 and 2016. The spa treatment counts, social insurance expenses, the territorial inequalities in utilization, sex and age distribution of the treatments were examined. RESULTS: The treatment counts were the highest (7 349 587) in 2009 and they gradually decreased with 6 558  204 treatments by 2012. 'Spa pool of medicinal water' treatment was the most common care in each year which incidence showed a downward trend during the past years: 2 544  617 treatments were performed in 2009 but 2016 showed only 1 898  338 treatments. We found the highest health insurance expenditures in 2016: 4.261 billion HUF or 13.8 EUR. In the previous years, there was a lower health insurance expenditure: in 2010 3.928 billion HUF (14.3 million EUR), in 2011 3.921 billion HUF (14.0 million EUR) and in 2012 3.875 billion HUF (13.4 million EUR). The utilization made the highest incidence of treatments in Csongrád county with 13 174/10 000 inhabitants and 8160 thousand HUF/10 000 inhabitants of social security subsidy in 2016. The lowest utilization counts for treatments were found in Nógrád county with 3233/10 000 inhabitants and 2192 thousand HUF/10 000 inhabitants of social security subsidy. The highest utilization indicators were found in the age group between 60 and 69 in the distribution of population and genders. CONCLUSION: In the utilization of spa therapy funded by health insurance fund, no significant change has occurred during the past years but territorial discrepancies can be seen in sex, age, and county breakdown. Orv Hetil. 2019; 160(Suppl 1): 22-28.

[Performance indicators of cardiac rehabilitation in Hungary]. / A kardiológiai rehabilitáció teljesítménymutatói Magyarországon.

INTRODUCTION: With the improvement of the survival of acute cardiac events and the increasing age, there is a higher demand for cardiac rehabilitation care. AIM: The aim of our study is to analyse the performance indicators of cardiac inpatient rehabilitation care in Hungary financed by the statutory public health insurance system. DATA AND METHODS: Data were derived from the financial database of the National Health Insurance Fund of Hungary. We analysed the period between 2014 and 2017. We investigated the distribution of cardiac rehabilitation hospital beds, the patient turnover and the rehabilitation rate following acute care. RESULTS: In 2017, there were 1765 publicly financed cardiac rehabilitation hospital beds in Hungary (1.8 beds/10 000 population). We observed the lowest number of hospital bed number in Szabolcs-Szatmár-Bereg (0.27 beds/10 000 population), Hajdú-Bihar (0.28) and Fejér (0.6) counties. We found the highest number of hospital beds in Veszprém (11.47 beds/10 000 population), Gyor-Moson-Sopron (4.94) counties and in Budapest (2.27). Between 2014 and 2017, the annual number of patients was between 24 834 and 26 146, while the number of nursing days varied between 510 thousand and 542 thousand. The average length of stay showed a moderate increase from 19.2 days/patient (2014) to 20.2 days/patient (2017). Only 6.6-7.6% of the patients who underwent acute myocardial infarction received cardiac rehabilitation care. CONCLUSION: We found significant regional inequalities in both the capacities and the access to and utilization of cardiac rehabilitation healthcare services, which should be mitigated by health policy activities. The low proportion (6.6-7.6%) of patients who underwent acute myocardial infarction and received cardiac rehabilitation care, should be increased. Orv Hetil. 2019; 160(Suppl 1): 6-12.

[Health policy indicators of neuromusculosceletal rehabilitation in Hungary]. / A neuromusculoskeletalis rehabilitáció szakmapolitikai indikátorai Magyarországon.

INTRODUCTION: With the increasing number of the incidence of neuromusculoskeletal and brain circulation disorders, there is a higher demand for neuromusculoskeletal rehabilitation care. AIMS: The aim of our study is to analyse the performance indicators of neuromusculoskeletal rehabilitation care in Hungary financed by the statutory public health insurance system. METHODS: Data were derived from the financial database of the National Health Insurance Fund of Hungary. We analysed the period between 2014 and 2017. We investigated the distribution of neuromusculoskeletal rehabilitation hospital beds, the patient turnover and patients' pathways. We analysed the regional inequalities in the access to (hospital beds) and utilization (number of patients) of rehabilitation care. RESULTS: In 2017, there were 6798 publicly financed neuromusculoskeletal rehabilitation hospital beds in Hungary (6.94 beds/10 000 population). We observed the lowest number of hospital bed in Komárom-Esztergom (1.5 beds/10 000 population), Somogy (2.0) and Pest (2.7) counties. We found the highest number of hospital beds in Zala (12.6), Gyor-Moson-Sopron (12.2) and Baranya (11.5) counties. The more than 2-fold difference in the utilization (Komárom-Esztergom: 52.3 patients/10 000 population; Gyor-Moson-Sopron: 136 patients/10 000 population) confirms regional inequalities. Between 2014 and 2017, the annual number of patients showed an increasing tendency, while the average length of stay varied between 21.8 and 22.4 days/patient. The correlation coefficient between hospitals beds and the number of patients was very high (0.798). CONCLUSION: We found significant regional inequalities in the access to and utilization of neuromusculoskeletal rehabilitation. Orv Hetil. 2019; 160(Suppl 1): 13-21.

[The patients' cost of the montelukast therapy due to the generic substitution]. / A montelukasztterápia betegterheinek változása a generikus árverseny hatására.

INTRODUCTION AND AIM: The aim of our study was to analyse the public price of the montelukast sodium therapy in Hungary. METHOD: Data derived from the nationwide pharmaceutical database of the Hungarian National Health Insurance Fund Administration. We observed the turnover and price of the medicaments containing the active substance montelukast sodium from 2007 to 2015. Accordingly, our indicators were: consumer price, DCT (daily cost of therapy), co-payment, quasi co-payment, DOT (days of treatment). RESULTS: Due to the increasing DOT, the total amount of the public price paid by the patients increased until 2011, reaching the amount of 1 million USD; then, due to the generic competition and the blind bid methods, it decreased to 490 000 USD. The total amount of the public price of the brand-name Singulair moved to the generics during 3 years (2011-2014). The DCT of the originator Singulair 10 mg tablets decreased from 1.1 USD to 0.34 USD; the DCT of the generic product Montelukast TEVA decreased from 0.67 USD to 0.16 USD in the period under review. CONCLUSION: Due to the generic competition, the patients' access to drugs containing montelukast sodium increased significantly: the DOT increased, the co-payment decreased. Orv Hetil. 2018; 159(17): 682-687.

[The effect of generic price competition on drug consumption and health insurance pharmaceutical expenditures in Hungary]. / A generikus árverseny hatása a gyógyszerforgalomra es a társadalombiztosítási támogatás kiáramláisra Magyarországon.

AIM: The aim of our study was to analyze the Hungarian montelukast sodium drug market. We examined the effect of the appearance of generic drugs on the price and turnover of the brand-name drug, Singulair. DATA AND METHODS: Data derived from the nationwide pharmaceutical database of Hungarian National Health Insurance Fund Administration (2007-2014). We analized the turnover and price of the medicaments containing the active substance montelukast sodium. Accordingly our indicators were: consumer price, social insurance subsidy, patients' co-payment and days of treatment (DOT). RESULTS: First the generics started from a significantly lower price of 18 USD which was lower than the price of brand-name Singulair (32 USD). Then the prices of the generics started to diminish. While in 2007 the DOT was below 2 million, it increased over 10 million days by 2014. The increase of DOT was followed by the increase of health insurance subsidy until 2011. Then the amount of health insurance subsidy decreased from 10,5 million USD to 7 million USD in 2012. In 2013 and 2014 there was a further reduction, the amount of the health insurance subsidy decreased to 4,1 million USD in 2013, and in 2014 it was reduced to 2.2 million USD. CONCLUSIONS: Following the introduction of generic drugs, the price of the medicaments containing montelukast sodium was significantly reduced, while the days on treatment (DOT) increased. The patients' access to drugs containing montelukast sodium increased significantly. The annual health insurance subsidy was significantly reduced as well.

The Hungarian Care Managing Organization Pilot Program.

OBJECTIVES: The aim of this article was to provide a description of the Hungarian care managing organization (CMO) pilot program and its environment, incentive structure, and preliminary outcomes. The need to change the behavior of doctors to increase the effectiveness and cost-effectiveness of the system was the key rationale for the Hungarian CMO pilot program. METHODS: After an application process, nine CMOs were entitled to enter into the system in July 1999. By 2006, there were 14 CMOs covering 2.1 million people. The Hungarian CMO program tried to combine the advantages of both the US managed care programs and the UK general practitioner fundholding system, within the constraints and opportunities of a Central-European country committed to a single-payer health insurance system. RESULTS: The revenue of CMOs derived from a risk-adjusted capitation. The capitation formula was weighted only by age and sex. The expenditures of the CMOs included all the health expenditures on their patients that occurred in any part of the health care system. The average savings rate for all CMOs for the fiscal years 1999 to 2007 was 4.94%. The highest rates of savings were realized in chronic and acute inpatient care and medical devices. The pilot was discontinued in 2008 without a comprehensive evaluation of the experience. CONCLUSIONS: We can conclude that this pilot had a significant contribution to the modernization of the Hungarian health care system.

[Experiences with price competition of biosimilar drugs in Hungary]. / A biohasonló gyógyszerek árversenyének tapasztalatai Magyarországon.

AIM: The aim of our study is to analyse the biosimilar bids of the Hungarian National Health Insurance Fund Administration in case of colony-stimulating factor and erythropoietin products. DATA AND METHODS: Data derived from the nationwide pharmaceutical database of Hungarian National Health Insurance Fund Administration. We analysed how the number of patients treated by colony-stimulating factor and erythropoietin products changed before (01.07.2011.-30.06.2012.) and after (01.07.2012.-30.06.2013.) the first biosimilar bid performed in March 2012 in Hungary. RESULTS: In the 12 months before biosimilar bid 4167 patients received erythropoietin treatment, while in the first 12 months after the bid 3647 patients, resulting in a 12.5 % decline. In the 12 months before biosimilar bid 13974 patients received colony-stimulating factor treatment, while in the first 12 months after the bid 13352 patients, resulting in a 4.5% decline. CONCLUSIONS: The analyses of the Hungarian price competition bid of biosimilar products showed a minimal decline in the number of patients under treatment by both colony-stimulating factor and erythropoietin products while the health insurance reimbursement of these drugs significantly decreased.

Changes in the health status of the population of Central and Eastern European countries between 1990 and 2010.

OBJECTIVE: The aim of this study was to analyse change in the health status of the population in the countries of Central and Eastern Europe (CEE) since 1990, compared with the 'old' EU-15 member states of the European Union (EU). METHODS: We analysed data from the Health for All Database and the Global Burden of Disease report of the World Health Organization (WHO). Life expectancy at birth and disability-adjusted life years were analysed for 1990-2010. Age-standardised death rates (ASDR) and potential years of life lost (PYLL) were assessed for selected inflammatory diseases. RESULTS: Life expectancy at birth for male individuals improved in CEE by 4.8 years and in the EU-15 by 5.4 years. During the same period, life expectancy at birth for female individuals improved in CEE by 4.0 years and in the EU-15 by 4.2 years. The difference in life expectancy at birth between male and female individuals in the EU-15 decreased by 1.2 years and in CEE by 0.8 years. Comparisons of ASDR and PYLL among the EU-15 and CEE countries were difficult because of the potentially low validity of the available data. CONCLUSIONS: The health status of the CEE population has improved since 1990. However, only a few countries have closed the gap with the EU-15 countries. Inflammatory conditions might represent a significant disease burden in CEE countries; however, a thorough analysis and comparison to the EU-15 is difficult because of a shortage of good-quality data.

[Analysis of health insurance data on home nursing care in Hungary]. / Az otthoni szakápolás egészségbiztosítási vonatkozásainak elemzése Magyarországon.

INTRODUCTION: Home nursing care was introduced in Hungary in 1996. AIM: The aim of this study was to analyse health insurance data and utilization indicators of the Hungarian home nursing care. METHOD: Data derived from the database of the National Health Insurance Fund Administration (2001-2012). The number of patients and visits, and the ratio of special nursing and special therapy (physiotherapy, speech therapy) were analysed. RESULTS: The number of patients increased by 41.3% from 36.560 (2001) to 51.647 (2012). The number of visits also increased by 41.9% from 841.715 (2011) to 1.194.670 (2012). Significant geographical inequalities were found in the ratio of special nursing and special therapy as well as nursing needs. The ratio of reimbursement for special nursing was the highest in county Nógrád (80.4%), Szabolcs-Szatmár-Bereg (79.7%) and Komárom-Esztergom (74.6%), while the lowest in county Zala (53.0%), Csongrád (52.7%) and Budapest (47.9%). CONCLUSIONS: There are significant inequalities in the home nursing care in Hungary. In order to decrease these inequalities, specific guidelines should be developed for home nursing care.

The effect of performance-volume limit on the DRG based acute care hospital financing in Hungary.

OBJECTIVES: The aim of our paper is to analyse the effect of the so-called performance volume limit (PVL) financing method on acute hospital care. DATA AND METHODS: The data were derived from the nationwide administrative dataset of the National Health Insurance Fund Administration (OEP) covering the period 2003-2008. We analysed the trends in the DRG cost-weights, number of cases, case-mix, and average length of stay. We calculated the average annual reimbursement rate per DRG cost-weight with and without the application of PVL degression according to the hospital type and medical professions. RESULTS: Our results showed that although the national case mix (i.e., the sum of all of the DRG cost-weights produced in one year) did not change between 2003-2006, the trend of the annual number of cases increased, and the average length of stay decreased. During 2007-2008, a significant decline was found in each indicator. The introduction of the PVL resulted in a health insurance budget saving of 1.9% in 2004, 2.6% in 2005, 3.4% in 2006, 5.6% in 2007, and 3.2% in 2008. We found the lowest reimbursement rate per DRG cost-weight at the university medical schools (HUF 138,200 or € 550) and children's hospitals (HUF 132,547 or € 528), whereas the highest was at the county hospitals (HUF 143,451 or € 571) and city hospitals (HUF 142, 082 or € 565). CONCLUSIONS: The implementation of the PVL reduced the acute care hospital activity and reimbursement. The effect of the PVL was different on the different types of hospitals, and it had a serious disadvantageous effect on the university medical schools and children's hospitals.