The structure and characteristics of the health care provision system

Contents:

1. The structure of the provision system

2. The regional differences of the health care provision system

7.1. The structure and characteristics of the health care provision

system

In Hungary the most important characteristic of the health care provision system is the shared responsibility and tasks between the state, the local authorities and the National Health Insurance system. The provision system is maintained by the independent financial basis of the national insurance, which manages the relevant charges collected by the National Tax Institution. This provision covers the whole population and provides full ranges of supply. The role of supplementary insurance is insignificant in Hungary.

Our provision system is a two-level system that is practically based on general practitioners. It is mainly owned by the state or the local governments, private or church properties are rare. Health care is financed dualistically:

costs of investments and maintenance are covered by the owner, the costs of the functioning are ensured by the Health Insurance Fund. Hungary spends 5% of their GDP on health care expenditure (World Bank 2010) which is less than developed EU countries spend (8-9%).

Let us list the elements that play a part in the structure and the running of the health care provision system.

Basic provision: It is the service that provides the population with the general, basic care (not specialised care).

Everyone can access and use it in their place of residence or near it. Basic provision is based on the long-term personal relationship of the doctor and the patient. Its goals and tasks are to protect and improve the good health of a given community, monitor the health of the individuals, inform and educate them in terms of health care, give treatment to them, rehabilitate them, attend to them in their homes if necessary, and refer them to specialists if necessary. Basic provision is traditionally established on practices, but in recent decades community and cooperative forms have emerged as well. Basic provision is not identical with the care of the practices for children (under 14), adults, and mixed practices for children and adults. GPs perform basic healing-preventative activities and collect and register all the health care data of their patients. GP practices are fundamentally financed by the health insurance, but GPs also accomplish professional tasks that are not funded by the health insurance for instance they may issue diagnostic results or expert opinion. Individuals have the fundamental right to choose their GP – considering the given regional and accessibility factors.

Specialty care: Specialty care is the health care provision given by a specialist specialised on a certain group of diseases that can be availed via a referral. The physician in order to solve a particular problem does diagnostic or/and therapeutic activity for a certain period of time. There is outpatient (ambulatory) and inpatient specialty care.

Ambulatory specialty care is one-off or occasional health care, or continuous care in the case of chronic diseases that do not require inpatient care. Ambulatory specialty care includes day surgery, which can replace hospital care, day care in hospitals and home specialty care. Ambulatory specialty care generally happens in ambulatory clinics. Ambulatory clinics provide at least four types of specialty care and there is radiological service and clinical laboratory service on the premises.

There are specialised provisions that are not confined to one place but operate in the form of On-the-Move Specialty Care, which means the patients of the region are visited in circulation. It is typically applied in maternal and infant health care.

Inpatient care means the health care provision supplied in inpatient health care institutes. According to the type of the care it may be active and chronic inpatient care.

Active inpatient care is the provision when the service is short-termed and can be planned. The aim of the care is to restore health as fast as possible or, if it is not aviable, to stabilise the status and prevent the occurrence of

complications. In the case of chronic diseases the care takes longer and the completion of the activity cannot be planned in general.

Hospital: it is the health care provision institute that is at the top of the health care provision system and is acknowledged by a professional supervisory board and as such provides inpatient care under constant medical control and professional supervision. According to law it has at least an internal medical division, a surgery division and another specialty according to progressivity, and also has ECG, US, radiology and a laboratory to supply the patients and has at least 80 beds.

Hospitals can be grouped according to their tasks and the services they provide. The high rank hospital classification means that the hospital has national ranges of duties. It is at the top of progressivity and in certain highly important areas of provision it provides for the whole of the country. Focal hospitals are high in the scale of progressivity and they provide significant inpatient care in a region (within the range of 50 km), and provide emergency care as well. There have been 39 such institutes in Hungary, but according to the new Semmelweis plan they will be replaced by 8 regional health care institutions. There will be 3 such institutes in Budapest.

(Figure 1)

Figure 1: So-called focal hospitals in Hungary (There used to be 9 such institutes in Budapest) (source:

http://www.logsped.hu/sulypontikorhaz.htm) (hospital within 50 minutes, hospital within 50-70 minutes)

District hospital provides general hospital care for a given region. They cooperate with other health care institutes in the region, the high rank hospitals, the ambulatory clinics and the GPs.

Specialised hospitals provide a full range of high level health care (2nd level progressive care) within one specialisation and in its related areas and have all the necessary diagnostic facilities. Universities of Medicine have joint clinical centres which besides performing healing activity provide the venues for medical practice.

The National Institutes and the National Health Care Institutes are national institutes that are maintained and financed by the Ministry or other governmental organisations. There are professional, methodical institutes and national health care institutes for instance ORFI, OORI, OKI.

It is necessary to highlight the Emergency Care Department which is the department of an institute – mainly hospital – that provides special care and is not organised according to a certain disease category but deals with cases when the status needs immediate intervention. Generally it is organised to deal with emergencies that endanger circulatory, breathing, brain, liver and kidney functions.

Nursing department or institute is a special inpatient care unit. It gives nursing services to those who need constant monitoring and nursing but do not require regular medical care. Home nursing is prescribed by a physician but is performed by a professional nurse. The aim is to provide the patients with personalised professional and humane nursing care in their own home environment.

Hospice (palliative) care aims to cease or soothe the pain or other excruciating symptoms of final phase patients suffering mainly from tumours. It is complex care that beyond improving the quality of life of the patients helps the family and supports the mourners.

The aim of the medical service out of consultation hours is to deal with the patients whose complaints need immediate care. Medical care is available after consultation hours thus making continuous health care provision possible. Basic non-stop care involves GP, GP paediatrician and dental services.

Rehabilitation is the collection of health care services that aim to restore or replace the functions (physical disability, speech disorder, reduced heart functions, infertility) that were lost to illnesses. It may also focus on the development of new compensational abilities (habilitation). Active rehabilitation can be built in the process of healing, delayed rehabilitation happens after dismissal. Medical rehabilitation includes physiotherapy, sport therapy, speech therapy, psychological care, employment therapy and teaching the use of medical appliances.

There are some useful terms to be mentioned in connection with patient care, the quality of services and accessibility as well.

The principle of progressivity means the hierarchical pyramid organisation of the health care provision system that is based on the distribution of tasks and has an obligatory system of connections and rules.

Scheduled patient care means that the patients make an appointment in advance for their health care service.

Scheduled patient care is only compulsory in the GP practices. GPs devote a certain amount of time of their consultation hours to taking care of scheduled patients; however, they certainly attend to the urgent cases in this time as well. Many experts say that scheduled care would be beneficial in the case of diagnostics and specialised care as well.

Waiting lists tend to be the necessary evil of health care provision. There is a general waiting list for the patients who require high cost provision; the transplant waiting list is one of these. Institutional waiting lists determine the order of patient care within a given hospital. Reducing the time patients have to wait is among the objectives of all health care reforms. Patients can find information in connection with the waiting list of an institute or a service on the internet as well.

The patient path is the method how care is organised. It is determined by the financer or owner that map out the chain of service providers a patient has to follow according to the particular illness that has to be treated. The general patient paths are the following: GP→ ambulatory specialty care → health centre or GP → district