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4. HEALTH CARE, ACCIDENTS

PUBLIC HEALTH

Expenditure on health

Expenditure on current health data is based on the international health accounts methodology (A System of Health Accounts 2011 Edition ), and does not contain data on investments. The new methodology was revised with the start of year 2013, and to assure comparability data was revised back to year 2003. In year 2016, due to methodological changes of NSDCP 2016 (Survey on Revenues and Expenditure of Non-public Health Providers), a break in time series was in case of voluntary health funds and household out-of-pocket payments. The break did not affect the aggregated values.

Current expenditure on health measures the final use of resident units of health care goods and services.

Within the national health accounts of Hungary:

Health care financing schemes by revenue sources constitute the increase in the funds through specific contribution mechanisms. The categories of the classification are the particular types of transaction through which the financing schemes obtain their revenues.

Source of data: Hungarian Central Statistical Office, NSDCP 2120: Health expenditure and income data, NSDCP 2016: Revenues and expenditures of nonbudgetary health organisations and other data collections of different statistical domains; Hungarian State Treasury: Budget data: final accounts, reports of health institutions, Hungarian National Bank: Private insurance enterprises' data.

Human resources of health service

Filled medical job: the number of appointed employees' jobs (except external deputies) at the end of the year, calculated for the number of employees working full-time. Included in the number of filled employments are those taken up as additional and secondary jobs.

Source of data: NSDCP 1019: Report on personnel of health service.

Active physician: a doctor who is admitted in the national medical register and is active.

Source of data: NSDCP 1589: Statistics on the distribution of physicians by region, specialist qualification, age and sex.

GP's and family paediatrician's service

General practitioner: provides personal, continuous, wide scale, long term basic health care service (health promotion, prevention and treatment diseases) in a given area. In addition to providing treatment and rehabilitation, he/she carries out regular screening, inspection of patients' health status, provides health information, refers patients to further examination by specialized institutions or hospital and certifies the ability to work.

Family paediatrician: provides basic care to children up to age of 14. Upon request he/she may continue to provide care to people aged 14–18 years. A paediatrician with area duties is obliged to provide care to, besides those who are registered with him/her, insured people in the area who have chosen another doctor, if they are unable to visit their chosen doctor.

Source of data: NSDCP 1021: Report on general practitioners' and family paediatricians' activities.

Health visitors' service

Health visitor: a health professional who has the following scope of duties: protection of women, care of expectant and confined mothers and 0-18 year-old children not attending school, and complex care of families. Her main activities are health care, prevention and health promotion.

Source of data: National Public Health Center, NSDCP 2087: Summary reports of health visitors.

Occupational health service

Occupational health service: a preventive service responsible for identifying and continuous controlling the workplace strains and pathogenic agents of working environment; making proposal for establishment and maintenance a safe and healthy working environment; the adaptation of work to the capabilities of workers in the light of their state of physicaland mental health; and performing health examinations of employees related to their work.

Source of data: National Public Health Center

Special home nursing

Special home nursing: according to the 20/1996. (VII. 26.) Ministry of Welfare Decree on special home care, it's an activity performed at the order of the nsuree's medical attendant by a specialized nurse at the insuree's home or residence. The Section 2 § (3) of the Decree particularly deals with the special qualifications (physiotherapist, physical therapist assistant, speech therapist qualifications) necessary to provide the special therapy service.

Visit: nursing activity performed at the order of the patient's medical attendant by a specialized nurse at the patent's home or residence.

Case: number of patients, to whom home special nursing was ordered irrespective of the length of care.

Patient: number of patients cared during the year irrespective how many times the nursing was ordered to him/her.

Source of data: Ministry of Human Capacities, NSDCP 2108: Report on home special care activity.

Outpatient service

Outpatient service: the examination and treatment of patients referred to or voluntarily attending specialized health care provided by medical staff with special qualification in an outpatient clinic or an outpatient department of an inpatient institution.

Number of attendances: the attendance of an outpatient at the consultation in a day irrespective of the number of services provided to her/him.

Number of interventions: the number of services provided to outpatients during the consultations of outpatient service.

Hours worked by a specialist: working hours performed by a specialist in outpatient service during a calendar year.

Hours worked by a non-specialist: hours worked by a non-specialist are separate activities performed in hours worked by a non-specialist ancillary health worker independently in her/his professional competence, under professional guidance of a specialist, but without her/his direct supervision (e.g. physiotherapy, physicotherapy, medical massage, dietetics, laboratory, psychology, medical pedagogy, speech therapy, etc.).

Source of data: Ministry of Human Capacities, NSDCP 2159: Data on outpatient service turnover.

Dentistry

Dental primary care: tooth and root extraction, cavity filling, root canal treatment and prosthesis excluding dental surgery.

Source of data: National Institute of Stomatology; reports of orthodontic and dental outpatients' clinics in 2005 ceased.

Dispensaries

A dispensary is a curative and preventive health care institution which provides care for outpatients suffering from certain specific diseases (pulmonary, psychiatric-mental, skin and venereal diseases or tumours, etc.). Dispensaries register and provide regular care for patients found and referred to a dispensary during patient care, furthermore, referred for special examination, found at screening or attending voluntarily the institution.

New patient: a patient registered and taken under treatment in the reference year; a TB or STD (sexually transmitted diseases) patient also who was discharged as cured after a previous treatment but relapsed.

Patient registered in a dispensary: a patient registered in a dispensary at a specific time (generally at the end of the year) and undergoing regular medical treatment or care (control) in the dispensary.

Tuberculosis and pulmonary care: Tuberculosis and pulmonary care comprises all curative and preventive pulmonary activities carried out in TB dispensaries. There is no obligation to report chronic pulmonary diseases other than tuberculosis and bronchial cancer, only those patients are registered who attend a pulmonary dispensary.

Pulmonary screening examination: A pulmonary screening examination is a medical examination by radiological and photographic methods carried out for the primary purpose of detecting pulmonary tuberculosis and pulmonary tumours.

Patient turnover: The number of patients who visited dispensaries during the reference year, considering every single visit.

New TB patients (incidence): Patients detected early by screening but for whom bacteriological tests prove negative and for whom sensitivity to the bacteriological test is not 100 per cent, and those certified bacteriologically positive.

Registered non-TB pulmonary patients: patients who are under treatment in a pulmonary dispensary at a specific date (31 December) because of a chronic non-TB pulmonary disease.

Bronchitis patients with obstruction: The disease involves the narrowing of the lower respiratory tract. Patients have permanent impairment and require regular specialist care.

Source of data: National Korányi Institute of Pulmonology; NSDCP 2083: Annual report on pulmonary dispensaries.

Skin and venereal care

Skin and venereal care covers the specialist treatment of patients with skin and sexually-transmitted diseases, the prevention of the spread of infections by regular interventions and the supervision of patients for a specified time.

Source of data: Ministry of Human Capacities, NSDCP 2084 Operational report of skin and venereal dispensaries.

Psychiatric and addictological care

Psychiatric patient: A person admitted to a psychiatric institution because of mental or behavioural dysfunction.

Estimated number of alcoholics: A datum derived from the number of deaths from liver cirrhosis, using the Jellinek formula (the number of deaths due to liver cirrhosis multiplied by 144).

Registered alcoholic is a person who was treated or taken under care in an addictology or psychiatric dispensary because of alcoholism and attended the dispensary at least once during the year.

Source of data: Ministry of Human Capacities, NSDCP 2086 Report on psychiatric dispensaries, NSDCP 2088 Report on care of addictological patients.

Treatment and morbidity of drug users

Drug users: people who consumed drugs daily or occasionally and were registered in the registers of drug ambulances and drug centres, psychiatric dispensaries, child and youth psychiatric wards and special ambulances, crises intervention wards, alcohology and addictology dispensaries and wards or special ambulances, drug therapeutic institutions.

Source of data: National Public Health and Medical Officer Service, NSDCP 2105: Report on drug consumers and their treatment.

Data have to be treated with the greatest possible care because of the uncertainty of data suppliers and other circumstances of data collection.

Inpatient service

Inpatient service: in the frame of inpatient services medical services (operation, examination or treatment) are provided. These services can be used by a patient upon the suggestion of the General Practitioner (family doctor), a specialist (or any other authorized person), or at the patient's request.

Hospital: a health care institution providing for longer-term patient stays, and, in addition, offering hotel-type services.

Number of approved hospital beds: the number of hospital beds available on 31 December of the reference year, covered by the operating permit issued by the National Public Health and Medical Officer Service. Spare beds, birthing beds, and beds for attendants, newborn infants, examinations and the health care personnel are not considered hospital beds.

Hospital bed in operation: an approved hospital bed suitable for hospitalisation (ready to receive patients after preparation) for at least 6 months during the reference period.

Discharged patient: a patient who, during the year, leaves the hospital or is transferred either to another ward in the same hospital or to another hospital, or who dies.

Number of day care cases: number of patients whose nursing time didn't reach 24 hours and received one of the interventions defined in the Appendix 9 of Ministry of Welfare Order 9/1993 (IV.2.).

Nursing day: care of a patient in a hospital for one day.

Average length of nursing (days): before 2019 measured by dividing the total number of nursing days worked in a hospital during a year by the number of discharged patients; from 2019 according to the methodology of National Health Insurance Fund Management of Hungary, the number of nursing days calculated on the full nursing period of discharged patients in the given year per the number of discharged patinets from wards in the given year.

Bed occupancy rate: the number of nursing days worked in a hospital expressed as a percentage of the number of workable nursing days.

Hospital mortality rate: the number of deaths in a hospital expressed as a percentage of the total number of patients discharged from there.

Source of data: National Health Insurance Fund Management of Hungary, NSDCP 2155: Summary report on hospitals' nursing cases. Unlike the report of National Health Insurance Fund, in current tables Szent Rókus Hospital belongs to Budapest and Szent Kozma and Damján Hospital (Visegrád) belongs to Pest county.

Ambulance tasks and patient transportation

Ambulances in operation: an ambulance participating in medical care directly and designated to performing ambulance tasks.

Rescue: the emergency care of the patient in need of care on the scene by organs entitled for rescue, transport of the patent if necessary to the nearest competent medical care provider suitable for the treatment of the patient's health problem, and providing medical care during transport.

Rescue transportation: ambulance mission when patient is transported by medical order - immediately or within two hours - from the place of discovery to a health institution under an ambulance nurse's supervision at least.

Protected transportation: transportation of patient from a health institution to another health institution by medical order under a medical, paramedical or ambulance nurse's supervision.

Patient transportation: providing access to health services on the basis of medical order in case of no other way of the access to health care can be ensured and the supervision of an ambulance nurse not equired.

Air rescue case: when the helicopter is the first medical support on the scene.

Air rescue transport: when the helicopter crew was not the first medical staff.

Source of data: NSDCP 1017: Statistical report on the activity of ambulance services and patient transportation.

Transfusion service

Unit of blood donation: in case of traditional blood donation, the donation of 450 ml (a10%) full blood in blood-preservative solution.

Source of data: National Blood Transfusion Service.

Public hygiene and epidemiology

Reported acute infectious diseases are all acute infectious diseases which have to be reported according to the decree, and when detected, demand epidemiological measures to be taken to prevent the diseases from further spreading.

Number of HIV-infected persons: includes the number of AIDS-patients, too.

Source of data: National Public Health Center.

Medicine supply

Consumer price of medicines: gross price aggregating any specific producer/importer price with associated maximized wholesale/retail margins.

Pharmacy: any service provider specialized in supplying medicines; any health care institution performing ancillary medicine retailing functions; may operate in public,branch, institute and pharmacy operated by a general practitioner subunit forms.

Public pharmacy: institute providing primarily the direct and complete medicine supply of sick people.

Branch pharmacy: pharmacies operating as stand-alone shops in larger pharmacy companies.

Pharmacy of institutions: any institutional subunit supplying medicines for operating any inpatient and veterinary institutes.

Pharmacy operated by a general practitioner: supplementary service providing specific medicines to general practitioners and family paediatricians.

Hospital internal pharmacy: institutional pharmacy subunit providing only prescription medicines for discharged patients and inpatient institute employees.

Data of prescription turnover: the health insurance expense relating to the given year from 1 January to 31 December.

Source of data: Ministry of Human Capacities, NSDCP 1578: Report on public pharmacies; NSDCP 1501: Report on the turnover of public pharmacies.

Diseases registered in primary care services

Diseases registered at the general practitioners' and family paediatricians' service data do not indicate the number of people but the number of the diseases of individuals (a person may have several diseases indicated in the register). The rates were calculated per ten thousand population of respective age and sex. At the inclusion in the age group, the age completed in the given year was taken into consideration. The diseases were denominated according to Revision X of ICD.

The population of the observations also included patients who were treated or cared for in another health institution, but were indicated in the GP's registration, too.

Source of data: Biannual morbidity insert related to the data collection of the Hungarian Central Statistical Office, entitled NSDCP 1021: Report on general practitioners' and family paediatricians' activities.

Congenital anomalies are morphological, biochemical or functional disorders developing – as an effect of genetic and/or environmental factors – in the foetal life and are noticed at birth (or in the prenatal or postnatal period).

During the application of the data, it has to be taken into consideration that disproportions in the number of reports do not allow getting an all-inclusive picture of the real situation. Since the middle of 2015, data supply has been performed in the system of eHCAR (online, electronic Hungarian Congenital Abnormalities Registry program).

Source of data: National Public Health Center, NSDCP 2101: Summary report on newborn children with congenital anomalies.

New reported malignant neoplasms

New malignant neoplasm patients (incidence): who were diagnosed with cancer during cancer screening provided by inpatient institutions, the oncology network or other health care institutions and who were registered at the National Cancer Register. The National Cancer Register examines the whole population, and from the reports on the discovered tumours builds up a database where the observation unit is the diagnosed malignant neoplasms. The cancer types are denominated according to Revision 10 of ICD.

Data collected by the National Cancer Register are under permanent revision according to the practice of the European cancer centres, so data have to be treated knowing that data on the previous year are surely and those on 3–5 years before are likely corrected.

Source of data: The National Institute of Oncology, NSDCP 1549: Summary report on neoplasms by the National Cancer Register.

Reduced working capacity

Person with reduced working capacity: Any working age person whose total health status was less than 60%. Opinions by the expert committee.

Categories of reduced working capacity:
– Category I: Total health status is 1–30%; of which: Group D (unable to work but not requiring other's care), Group E (completely unable to work and requiring other's care).
– Category II: Total health status is 31–50%; of which Group C1 (with a possibility for rehabilitation), Group C2 (without a possibility of rehabilitation).
– Category III: Total health status is 51–60%; of which: Group B1 (with a possibility for rehabilitation, suggested for complex rehabilitation (rehabilitation annuity)), Group B2 (without a possibility of rehabilitation complex rehabilitation is not suggested).

Comparability of data are restricted due to the changes in rules effecting qualification system in 2008 and 2012.

Before 2008:
Disabled person: active wage/salary earner of working age whose ability to work has deteriorated by at least 67% as a result of physical or mental deficiency or deterioration in his condition of health; or by 50% in consequence of silicosis. Disability categories:
–I.: completely unable to work and requiring other's care
–II.: completely unable to work but not requiring other's care
–III.: disabled but not completely unable to work.

Between 2008-2012:
Disabled person: Any working age person whose total health deterioration is 80–99% (category I–II.) or total health deterioration is 50–79% (category III.) and complex rehabilitation is not suggested. Disability categories:
–I.: completely unable to work and requiring other's care
–II.: completely unable to work but not requiring other's care
–III.: disabled but not completely unable to work

Source of data: Hungarian State Treasury

Self-perceived health, chronic illness, disability (HBLS/EU-SILC)

Self-perceived health: as the respondent subjectively perceives his/her general health that includes different (i.e. physical, social and emotional) dimensions.

Suffer from any chronic (long-standing) illness or condition: long-standing illnesses or health problems having lasted (or recurred) or are expected to last (recur) for 6 months or more. Those long-standing diseases that don't influence the everyday life of the respondent and/or are kept under control with medication are also included.

Limitation in activities because of health problems: if the respondent has a longstanding health problem that causes a reduction in his/her everyday activities. Activity limitations are defined as "the difficulties the individual experience in performing an activity", where the reference is to activities people usually do. The limitations must have started at least six months ago and still exist at the moment of the interview. From 2019 instead of the previous one question Hungarian Central Statistical Office asks seperate questions about the extent and duration of limitation.

Source of data: HBLS/EU-SILC

The aim of the Household Budget and Living Conditions Survey (HBLS) of the Hungarian Central Statistical Office is to collect data on income and living conditions of Hungarian households. Based on representative probability samples, we collect data about 8,000 households1 and 20,000 persons of the target population annually. Among the target primary variables are data on self-perceived health, health behaviour and access to health care services. EU-SILC statistics on income and living conditions are based on the data from HBLS.

In published tables, according to domestic practice, we consequently indicate the reference period of the data, unlike Eurostat tables where the year of data collection is published. In case of general health, chronic illness and limitation, the reference period is the year of data collection, but in case of unmet need for medical examination or treatment, data refer to the year preceding the data collection.

Healthy life years (HLY)

The Helathy Life Years (HLY) indicator gives the number of years without limitation because of health problems.

As recommended by Eurostat, Hungarian Central Statistical Office has been applying the most common used Sullivan-method to calculate the indicator based on age specific morbidity data and prevalencies of disability from EU-SILC survey since 2015. Because of minor methodological differences domestic values are differ from those calculated by Eurostat. From 2019 instead of the previous one question Hungarian Central Statistical Office asks seperate questions about the extent and duration of limitation in SILC survey, so changes in HLY can not be interpreted directly as changes in helathy life expectancy.

Until 2014 calculations of HCSO are published.

ACCIDENTS

Accidents at work: a reported accident healing over three days, which occurred to a person in the course of his/her organised work or in relation to it, irrespective of the place and time of the accident. Fatal accidents at work: a labour accident the victim of which dies within 1 year as a result of the accident, as attested by a doctor's opinion.

Data on accidents at work according to the European Statistics on Accident at Work (ESAW): data from harmonised data collection of the European Union on accidents at work. Under the terms of the Commission Regulation (EU) No 349/2011 of 11 April 2011 Member States shall transmit microdata on persons who had an accident in the course of work during the reference period and the associated metadata according to the methodology of European Statistics on Accident at Work.

Data on accidents at work and their metadata are published by Eurostat on the following website: http://ec.europa.eu/eurostat/data/database

Source of data: Ministry of Innovation and Technology.

Fatal home accident: death resulting from an accident which occurred in the victim's place of residence or place of stay. All fatal events caused directly by home accidents are registered as fatal home accidents, regardless of the time passed between the accident and the death. The place of residence is the address of the dwelling where the person lives. The place of stay is the address of the dwelling where the person stays for more than 3 months without intending to leave finally his/her place of residence.

Fire case: a process of burning which endangers life, bodily integrity or material property, or causes damage to these.

Source of data:
Data on accidents at work are sent to the HCSO by the Ministry of National Economy.

The source of data for fire outbreaks and emergency cases is the National Directorate General for Disaster Management, Ministry of the Interior.

Fatal home accident figures are produced by the Central Statistical Office from mortality statistical records.

 

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