Hungary Preparing For The Health Care Future. Challenges in the changing hospital and healthcare environment

Transcription

1 Hungary Preparing For The Health Care Future Challenges in the changing hospital and healthcare environment

2 Magyarország HUNGARY QUALITY FIRST QUALITÄT ZUERST KVALITÉT FÖRST CALIDAD PRIMERO ELSÖ A MINÖSÉG

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

4 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).

5 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)

6 The Hungarian Health Care System Players Ministery OBDK OEP GYEMSZI Local Owners Inpatient Care Acute/Chronical Integrated Outpatient Care Primary Care Patient

7 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

8 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.) regions on new health care XXXVIII. Act (24. May, 2012) on the governmental over taking of inpatient and outpatient specialist care institutions managed by municipal governments Government Decree 92/2012. (27. Apr., 2012) on the detailed rules of the nationalization of the specialist health care providers Government Decree 46/2012. (28. Mar., 2012) on centralized drug, medical equipment and desinfectant procurement

9 The Semmelweis Plan (4th Nov., 2010.) Whitepaper for public policy discussions on the Hungarian health government s key objectives and related action plans Enhancement of efficiency Improvement of access Reproduce the system s conformity: regional planning Cooperation between the players 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

10 GYEMSZI Responsibility Gyógyszerészeti 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 stateowned and managed healthcare system The goal is to ensure financial sustainability & reduce geographical differencies in access via: Promoting the functional cooperation of different health care institutions Establishing regional health care planning and management in 8 regional geographical areas for million inhabitant units Establishing the National Center for Patient Right and Documentation as a single point of contact to report malpractice issues and ensure patient rights Improvement of the HR situation of the institutions

11 GYEMSZI Regionalized HC Management Gyógyszerészeti 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 level Considerations: Respect the county lines (where possible) Define a region from an area where patient migration is low (under 10%)

12 GYEMSZI New Classifications Gyógyszerészeti 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 hospital Specialised care National institute Specialised hospital Nursing centre

13 Map of Regionalized HC Management Western Transdanubia Population: (14%) Number of acut beds: 5025 Number of LTC beds: 4957 Western Central Hungary Population: (11%) Number of acut beds : 5186 Number of LTC beds : 3358 Northern Central Hungary Population: (16%) Number of acut beds : 5789 Number of LTC beds : 4913 Northern Hungary Population : (9%) Number of acut beds : 3715 Number of LTC beds : 2256 Northern Great Plain Population: (12%) Number of acut beds : 5207 Number of LTC beds : 2442 Southern Transdanubia Population: (9%) Number of acut beds : 4047 Number of LTC beds : 2790 Southern Central Hungary Population: (15%) Number of acut beds : 7623 Number of LTC beds : 3791 Southern Great Plain Population: (14%) Number of acut beds : 5674 Number of LTC beds : 2909

14 OEP Responsibility Országos Egészségbiztosítási Pénztár National 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 ( 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.)

15 OEP Quality Issues Országos Egészségbiztosítási Pénztár National 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 graduate education) Licensing of new technologies and drugs (~ 500 p.a.) Contracting with HC providers (~ 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 (

16 OBDK Országos 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

17 OBDK Methods used Országos 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

18 OBDK New Possibility Országos 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 demand of 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 the recommendation within 60 days

19 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

20 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 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

21 MEES Inpatient 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

22 MEES Outpatient 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 hospital The patient will be informed by a special trained person about the 1. admission 2. how that particular institution works 3. waiting lists 4. how to make an appointment 5. 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).

23 MEES General 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...

24 MEES General 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)

25 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 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

26 Good practice examples I

27 Good practice examples II 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

28 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

29 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

30 Marina Salud. Departamento de Salud de Denia Uzsoki Hospital

31 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

32 Good practice examples IV MediVIR 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

33 Good practice examples V National Indicator System, Topics: General Data Workplace Data (Bed per room, etc.) Nosocomial Infections Children Oncology Intensive Care Cardiology Geriatry Human Resource

34 Good practice examples..more 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, )

35 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

36 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

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

38 Conclusions What s considered to be quality in healthcare? What s done to improve quality in healthcare?... and the Patient Relation Management?

39 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)

40 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)

41 ... 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)

42 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

43 Thank You, for Your Attention Franciesca Christina Heinrich