national quality policy in hungary lászló gulácsi, enqual country coordinator for hungary...

National Quality Policy in Hungary

László Gulácsi, ENQual country coordinator for Hungary

Associate Professor

Budapest University of Economic Sciences

Unit of Health Economics and Health Technology Assessment HunHTA

Presented at the second ENQual workshop

STAKES, Helsinki 2-3 April, 2004

HunHTA Unit of Health Economics and Health Technology Assessment

Acknowledgement

Special Advisors to the ENQual Hungary:

Ildikó Szy (Ministry of Health)

András Ajtay (National Health Insurance Fund)

Erika Takács (National Health Insurance Fund)

József Topár (University of Technology, Budapest)


Quality – history in Hungary

1992-1997 Starting point: The European Concerted Action Programmes on Quality Assurance in Hospitals (COMAC/HSR/QA, BIOMED/PECO), (465 hospitals in 14 countries) – Prof. Niek S. Klazinga

1991 - Quality and Accreditation Board, , the Ministry of Welfare

1992 – Hungarian Society for Quality in Health Care

1992 - Quality Assurance Department, Ministry of Welfare

1994 - Quality Assurance Education and Consultation Centre, Ministry of Welfare


Act CLIV of 1997 on Health - Hungary

In Hungary, the “Act CLIV of 1997 on Health” makes the operation of a quality assurance system obligatory for every health institution.

The health care Act in its chapter entitled “Professional requirements for health care services” points out that the aim of establishing a set of professional requirements is to ensure the appropriate quality of health services with special respect to efficacy and effectiveness.


Internal quality management

Act CLIV of 1997 on Health, implemented in January 1st 1999, made the operation of the internal quality systems in health care settings mandatory. The main aims of the quality systems in the health care settings are as follows:

• (1) The aim of the quality system is to ensure the quality of health care services.

• (2) To achieve this aim, the quality system includes:

- specification of quality requirements

- inspection and evaluation of the fulfilment of requirements

- certification if necessary

- continuous quality improvement


Internal quality management

• (3) The basic criteria of maintaining quality:

- Only those providers should provide services, which meet the personal and material conditions as required by the relevant legislation.

- In the course of health service delivery, the relevant legislation and professional rules and standards should be met, more specifically, the guidelines which rest on the evidence-based medicine and represent the state of the art.


Daily practice

Legislation does not identify what kind of quality improvement activities should be performed in the daily practice, what kind of processes should be created, what kind of indicators should be set related to the structure, process or outcome.


Quality management/improvement systems

• ISO : 9000-20000

• EFQM

• Hospital Accreditation Standards (JCI)

Certification only! (accreditation is only for labs, no hospital accreditation

body)


ISO : 9000:20000

Wide diffusion of the ISO:9000:2000 standards

70 hospitals from the 164 (all departments – total hospitals are certified)

Manual for ISO implementation, 2003 (Ministry of Health – www.eszcsm.hu)


Hospital Accreditation Standards

JCI adaptation

Certification (NOT accreditation)

17 hospitals (from the total number of 164)


EFQM

Self assessment is used by 14 hospitals


Quality improvement activities and results

Practice guidelines18 guidelines were published already in the Official Gazette of the Ministry of Health; from various fields from the health care (Szy I, Sinka M, Horváth A, Gulácsi L)

Indicators / Ministry of Health37 indicators were published already in the Official Gazette of the Ministry of Health; from various fields of the health care (Szy I, Sinka M, Rubecz I, Gulácsi L)


Quality improvement activities and results

Indicators / National Health Insurance Fund

Indicator setting based on already existing database (hospital performance) and being used for remuneration under DRG (Hungarian type of DRG – HBCS) financing mechanism

Quality management systems and quality control / National Health Insurance Fund

Further assistance is provided to hospitals to create quality systems and committees and more directed quality control is planned based on professional guidelines and indicators


Plans for the future

Hospital accreditation Standards / continuous revisit and improvement – managed diffusion to more provider

EFQM Excellence Model / more provider should use self assessment

National Quality Award for health care providers / being established

Standardised computerised nationwide patient satisfaction survey / being established

National Indicator System / being created

National Audit Programme / being created


References

Szy I, Tímár K, Sinka M, Pályázat IIASA-SHIBA Díjra (Application for IIASA SHIBa Award), Ministry of Health, Budapest, 2003

Ajtay A, Puskás J, Minőségügyi helyzet az egészségügyben 2003 (Quality status of the Hungarian Health care system, 2003), National Health Insurance Fund, Budapest, 2003

Gulácsi L, Hungarian health care in transition; Studies on the improvement of the effectiveness of health care in Hungary by implementing quality assurance, University of Amsterdam, 2001

national quality policy in hungary lászló gulácsi, enqual country coordinator for hungary...

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