Hálapénz a magyar egészségügyben = Gratitude money in the Hungarian health sector

A tanulmány szerzői lakossági és orvosi minta kikérdezése alapján arra keresik a választ, hogy a valóságban mennyire elterjedt a hálapénz adása és elfogadása a magyar egészségügyben, miként szóródik az egyes orvosi szakmák között, és mekkora az egyes beavatkozási formák hálapénzára. A kapott eredmények szerint, a hálapénzárak nyilvánossá tételének korlátai ellenére a piac szereplői többé-kevésbé egyöntetűen ítélik meg, mi mennyibe kerül. A szerzők megbecsülik az egy év leforgása alatt kifizetett hálapénz összegét. Ennek alapján arra a következtetésre jutnak, hogy az "átlagorvos" hálapénzből származó bevétele bő másfélszerese hálapénz nélkül vett jövedelmének. __________ The authors examine the incidence, in the Hungarian health sector, of gratitude payments from patients to doctors, based on a questionnaire administered to samples of the public and of the medical profession. They look at how the payments are distributed among the branches of medicine, and what payment is customary for various medical treatments. The survey findings show that although there are constraints on public knowledge of the size of gratitude payments, market actors more or less agree in their estimates of what provisions cost. Based on this, the authors conclude that the income the "average" doctor receives from gratitude payments is at least one-and-a-half times as much as his or her income apart from gratitude money.

Egészségügyi reform Horvátországban (Health reform in Croatia)

A horvátországi egészségügyi reform célja a decentralizáció elvén alapuló egészségügyi rendszer létrehozása volt. Az egészségügyi szolgáltatások költségnövekedése által okozott terheket a központi költségvetés helyett egyre nagyobb mértékben a lakosság viseli, miközben kiegészítő biztosítás létrehozásával megkísérelték csökkenteni a változások nemkívánatos következményeit. A gyógyszer-finanszírozási rendszer átalakításával a költségcsökkentés mellett el akarták érni, hogy a betegek nagyobb arányban jussanak hozzá a modern, innovatív gyógyszerekhez. ________ The Croatian health care system faced great challenges during the1990s. The aim of the paper is to review some important aspects of the Croatian health care reform. Establishing a decentralized health care system was an important section of the reform. As a new element of the health insurance system, burdens generated by the increase of costs of health services have fallen on the society increasingly, while complementary health insurance tried to decrease the undesirable consequences of the changes. The objective of the drug-financing reform was to reduce the costs and improve access to innovative medicines as well. As regards the success of the reforms, besides increasing incomings, the method and result of the spending of the health insurance funds is crucial.

Comparing cost-sharing practices for pharmaceuticals and health care services among four central European countries

The paper reviews the existing cost-sharing practices in four Central European countries namely the Czech Republic, Hungary, Poland and Slovakia focusing on patient co-payments for pharmaceuticals and services covered by the social health insurance. The aim is to examine the role of cost-sharing arrangements and to evaluate them in terms of efficiency, equity and public acceptance to support policy making on patient payments in Central Europe. Our results suggest that the share of out-of-pocket payments in total health care expenditure is relatively high (24–27%) in the countries examined. The main driver of these payments is the expenditure on pharmaceuticals and medical devices, which share exceeds 70% of the household expenditure on health care. The four countries use similar cost-sharing techniques for pharmaceuticals, however there are differences concerning the measure of exemption mechanisms for vulnerable social groups. Patient payment policies for health care services covered by the social health insurance are also converging. All the four countries apply co-payments for dental care, some hotel services or in the case of free choice of physician. Also the countries (except for Poland) tried to extend co-payments for physician services and hospital care. However, their introduction met strong political opposition and unpopularity among public.

Preferences of Hungarian consumers for quality, access and price attributes of health care services — result of a discrete choice experiment

In 2010, a household survey was carried out in Hungary among 1037 respondents to study consumer preferences and willingness to pay for health care services. In this paper, we use the data from the discrete choice experiments included in the survey, to elicit the preferences of health care consumers about the choice of health care providers. Regression analysis is used to estimate the effect of the improvement of service attributes (quality, access, and price) on patients’ choice, as well as the differences among the socio-demographic groups. We also estimate the marginal willingness to pay for the improvement in attribute levels by calculating marginal rates of substitution. The results show that respondents from a village or the capital, with low education and bad health status are more driven by the changes in the price attribute when choosing between health care providers. Respondents value the good skills and reputation of the physician and the attitude of the personnel most, followed by modern equipment and maintenance of the office/hospital. Access attributes (travelling and waiting time) are less important. The method of discrete choice experiment is useful to reveal patients’ preferences, and might support the development of an evidence-based and sustainable health policy on patient payments.

Formal professional relationships between general practitioners and specialists: possible associations with patient health and pharmacy costs

This article investigates whether the strength of formal professional relationships between general practitioners (GPs) and specialists (SPs) affects either the health status of patients or their pharmacy costs. To this end, it measures the strength of formal professional relationships between GPs and SPs through the number of shared patients and proxies the patient health status by the number of comorbidities diagnosed and treated. In strong GP–SP relationships, the patient health status is expected to be high, due to efficient care coordination, and the pharmacy costs low, due to effective use of resources. To test these hypotheses and compare the characteristics of the strongest GP–SP connections with those of the weakest, this article concentrates on diabetes—a chronic condition where patient care coordination is likely important. Diabetes generates the largest shared patient cohort in Hungary, with the highest traffic of specialist medication prescriptions. This article finds that stronger ties result in lower pharmacy costs, but not in higher patient health statuses. Key points for decision makers • The number of shared patients may be used to measure the strength of formal professional relationships between general practitioners and specialists. • A large number of shared patients indicates a strong, collaborative tie between general practitioners and specialists, whereas a low number indicates a weak, fragmented tie. • Tie strength does not affect patient health—strong, collaborative ties between general practitioners and specialists do not involve better patient health than weak, fragmented ties. • Tie strength does affect pharmacy costs—strong, collaborative ties between general practitioners and specialists involve significantly lower pharmacy costs than weak, fragmented ties. • Pharmacy costs may be reduced by lowering patient care fragmentation through channelling a general practitioner’s patients to a small number of specialists and increasing collaboration between general practitioner and specialists. • Limited patient choice is financially more beneficial than complete freedom of choice, and no more detrimental to patient health.

The impact of the recession on health care expenditure — How does the Czech Republic, Hungary, Poland and Slovakia compare to other OECD countries?

In the past few years, several papers have been published in the international literature on the impact of the economic crisis on health and health care. However, there is limited knowledge on this topic regarding the Central and Eastern European (CEE) countries. The main aims of this study are to examine the effect of the financial crisis on health care spending in four CEE countries (the Czech Republic, Hungary, Poland and Slovakia) in comparison with the OECD countries. In this paper we also revised the literature for economic crisis related impact on health and health care system in these countries. OECD data released in 2012 were used to examine the differences in growth rates before and after the financial crisis. We examined the ratio of the average yearly growth rates of health expenditure expressed in USD (PPP) between 2008–2010 and 2000–2008. The classification of the OECD countries regarding “development” and “relative growth” resulted in four clusters. A large diversity of “relative growth” was observed across the countries in austerity conditions, however the changes significantly correlate with the average drop of GDP from 2008 to 2010. To conclude, it is difficult to capture visible evidence regarding the impact of the recession on the health and health care systems in the CEE countries due to the absence of the necessary data. For the same reason, governments in this region might have a limited capability to minimize the possible negative effects of the recession on health and health care systems.

The impact of the recession on health care expenditure — How does the Czech Republic, Hungary, Poland and Slovakia compare to other OECD countries?

In the past few years, several papers have been published in the international literature on the impact of the economic crisis on health and health care. However, there is limited knowledge on this topic regarding the Central and Eastern European (CEE) countries. The main aims of this study are to examine the effect of the financial crisis on health care spending in four CEE countries (the Czech Republic, Hungary, Poland and Slovakia) in comparison with the OECD countries. In this paper we also revised the literature for economic crisis related impact on health and health care system in these countries. OECD data released in 2012 were used to examine the differences in growth rates before and after the financial crisis. We examined the ratio of the average yearly growth rates of health expenditure expressed in USD (PPP) between 2008–2010 and 2000–2008. The classification of the OECD countries regarding “development” and “relative growth” resulted in four clusters. A large diversity of “relative growth” was observed across the countries in austerity conditions, however the changes significantly correlate with the average drop of GDP from 2008 to 2010. To conclude, it is difficult to capture visible evidence regarding the impact of the recession on the health and health care systems in the CEE countries due to the absence of the necessary data. For the same reason, governments in this region might have a limited capability to minimize the possible negative effects of the recession on health and health care systems.

A gyógyszerkiadás és a betegek egészségi állapota a háziorvosi és szakorvosi kapcsolatok függvényében = Formal professional relations between general practitioners and specialists. Possible links with patient health and pharmacy cost

Arra a kérdésre keressük a választ, hogy a szoros háziorvosi-szakorvosi szakmai kapcsolatoknak van-e hatásuk a betegek gyógyszerkiadására, illetve egészségi állapotára. Az orvosok közötti szakmai kapcsolatok szorosságát a közösen gondozott betegek száma alapján határoztuk meg, míg a betegek egészségügyi állapotát a diagnosztizált és kezelt társbetegségek számával mértük. Hipotézisünk egyrészt az volt, hogy a hatékonyabb koordinációnak köszönhetően a szoros kapcsolatban kezelt betegek jobb egészségi állapotúak, másrészt kezelésük az erőforrások hatékonyabb felhasználása miatt kisebb gyógyszerköltséggel jár. E két hipotézist a cukorbetegekre teszteltük. Azért esett erre a krónikus betegségre a választásunk, mert itt a háziorvosok és a szakorvosok együttműködése elsődleges fontosságú. Magyarországon a cukorbetegek esetében a legnagyobb a közösen kezelt betegek populációja, valamint itt a legmagasabb a szakorvosi javaslatra felírt háziorvosi receptek száma. Azt az eredményt kaptuk, hogy a szoros kapcsolatban kezelt betegek nem rendelkeznek sem jobb, sem rosszabb egészségi állapottal, miközben a kapcsolódó gyógyszerkiadásuk szignifikánsan alacsonyabb. ____ The article considers whether strong formal professional relations between GPs and specialists in shared care affect either the health of patients or the pharmacy costs they incur. The strength of such relations is measured by the number of shared patients; patient health is proxied by number of co-morbidities diagnosed and treated. The first hypothesis is that patients treated amid strong GP-specialist relations have better health status than those treated amid weak ones, due to enhanced efficiency of care coordination. The second is that patients treated in such strong relations incur lower pharmacy costs high numbers of shared patients are assumed to promote appropriate, effective use of resources. The article tests these hypotheses and compares the outcomes of the strongest and weakest GP-specialist relations through the example of diabetes, a chronic condition where patient-care coordination is important. Diabetes generates the largest shared patient cohort in Hungary, with the highest number of specialist medication prescriptions. This article finds that stronger ties result in significantly lower pharmacy costs, but not a higher patient health status.

A lean elvek alkalmazása az egészségügyi folyamatok fejlesztésében = Applying lean principles in healthcare process development

A fejlett társadalmak egészségügyi szolgáltató rendszerei napjainkban kettős kihívással néznek szembe: miközben a társadalom a szolgáltatási színvonal emelkedését, a hibák számának a csökkenését várja el, addig a költségvetési terhek miatt a költségcsökkentés is feltétlenül szükséges. Ez a kihívás nagyságában összevethető azzal, amellyel az USA autóipara nézett szembe az 1970-es évektől. A megoldást az autóipar esetében a konkurens „lean” menedzsment elvek és eszközök megértése és alkalmazása jelentette. A tanulmány arra keresi a választ, hogy vajon lehetséges-e ennek a megoldásnak az alkalmazása az egészségügy esetében is. A cikk az egészségügy problémájának bemutatása után tárgyalja a lean menedzsment kialakulását és hogy milyen módon került köztudatba. A tanulmány második felében a szakirodalomban fellelhető, a témával kapcsolatos tapasztalatokat foglalja össze, majd levonja a következtetéseket. = In developed societies healthcare service systems are facing double challenge; society expects service level to rise and the number of mistakes to drop, but at the same time, because of the overloaded budgets, cutting cost is also absolutely necessary. This challenge compares to the one the US automotive industry was facing in the 1970-s. In case of the automotive industry the solution was the comprehension and application of the principles and the tools of lean management. This study aims to answer the question whether it is possible to apply this solution also in the case of the healthcare system. The article first introduces the problems in the healthcare system, than describes the formation of lean management concept and its wide spread. The second half of the study summarizes the available knowledge in the literature and drives conclusions.

A Theory of Natural Addiction

Economic theories of rational addiction aim to describe consumer behavior in the presence of habit-forming goods. We provide a biological foundation for this body of work by formally specifying conditions under which it is optimal to form a habit. We demonstrate the empirical validity of our thesis with an in-depth review and synthesis of the biomedical literature concerning the action of opiates in the mammalian brain and their eects on behavior. Our results lend credence to many of the unconventional behavioral assumptions employed by theories of rational addiction, including adjacent complementarity and the importance of cues, attention, and self-control in determining the behavior of addicts. We oer evidence for the special case of the opiates that "harmful" addiction is the manifestation of a mismatch between behavioral algorithms encoded in the human genome and the expanded menu of choices faced by consumers in the modern world.

A magyar öngondoskodás sajátosságai

A magyar nyugdíjrendszerben 1998 óta egymás mellett működik a felosztó-kirovó és a kötelező tőkefedezeti pillér. Ezt a paradigmatikusnak tekintett reformot követően is több változtatás zajlott az elmúlt években, amelyek lényegében a nyugdíjparaméterek módosítására irányultak. Mára a nyugdíjreformról szóló diskurzus világszerte újra általánossá vált. A magyar nyugdíjviták középpontjában nem elsősorban az idősödő népesség növekvő aránya, hanem az alacsony foglalkoztatás és a csekély jogosultságszerzés áll. A hozzászólások ma már nem a felosztó-kirovó versus tőkefedezeti rendszer kérdéskörét érintik. A vitában újra és újra előkerül az öngondoskodás hangsúlyozása. A tanulmány egy felmérés adatain keresztül elemzi az öngondoskodás különböző formáinak elterjedtségét. A kérdőív tanulsága szerint a megkérdezettek jellemzően nem saját maguk hozták meg döntéseiket a vizsgált kérdésekben - a nyugdíjrendszerről és saját várható nyugdíjas élettartamukról korlátozott (és néha téves) ismeretekkel rendelkeznek. Az emberek öngondoskodásának túlhangsúlyozása a szerzők szerint meg nem engedhető optimizmus. /===/ Unfunded and mandatory funded pillars of the Hungarian pension system have been operating simultaneously since 1998. This reform, seen as paradigmatic, has undergone several changes in recent years, designed essentially to alter the pension parameters. Discourse on pension reform has become general again throughout the world. The pension debates in Hungary have focused less on the rising proportion of the elderly than on low employment and eligibility. Contributions to the debate these days are not about the question of an unfunded versus a funded system. The emphasis has repeatedly been on self-provision. The study analyses by means of survey data the extent of the various forms of self-provision. The survey shows that respondents have not typically made decisions of their own on the matter, for which they have limited (and sometimes false) information about the pension system and their life expectancy as pensioners. According to the authors, it is impermissibly optimistic to place excessive emphasis on people’s ability to provide for themselves.