Hungarian Hospital Association: Health care financing should be reformed

English2020. jan 9.Péter Harsányi

Applying innovative solutions in health care would both reduce patient recovery times and help ease acute labor shortages in healthcare.  Növekedé talked to Andrea Ficzere, the newly appointed president of the Hungarian Hospital Association who believes health care financing should be reformed.

What fields are most in need of innovation and digitization?

All areas. Those areas where innovation could bring immediate results are also the ones where labor shortages are the highest. Information technology (IT) developments are essential everywhere and should be financed.

Clinics, healthcare centers and even smaller hospitals should adopt new medical devices and methods.

For example, electronic fever charts, nurse calling systems, telemedicine, and patient monitoring devices could all ease the workload of the nursing staff while providing safer, higher quality care. Artificial intelligence (AI)-based technologies could support the decision-making process and complement doctors’ work. Over time these technologies will not only support, but in many cases take over, many medical tasks. Their self-learning abilities enable them to spot conditions that humans cannot.  

What other benefits would the above developments bring about?

On the one hand, curing patients would be more efficient and done more accurately using these new tools. On the other hand, medical or nursing staff shortages would be less painful.

Applying the new methods would help patients access treatment more rapidly whenever it is justified. Eventually, using more accurate methods will avoid many complications, which would decrease future treatment costs.

The healing process would also become shorter, allowing patients to return to work sooner. At a system level, this would bring about substantial economic benefits. Investments that initially seemed expensive would be rewarded over time, while social welfare would also improve.

Should health care financing be restructured?

Absolutely. Today, institutions receive funding based on capacity.

It would make more sense to fund them based on quality [of service] and results. This would make funding more efficient, easier to calculate and more accountable. It would reveal where it is justified to maintain acute beds and where there is greater need for chronic care. In other words, financing should be dependent on the patient.

If they decide to use the services of another institution where, based on the information they have, treatment is safer and more efficient, then resources should be allocated there.

Many reputable, efficient institutions with large, local service regions face the problem of exceeding their performance volume limit. This occurs because – for professional and moral reasons – they choose not to send away the masses of patients they receive. Even though [turning patients away] is what we are expected to do if we were to act solely on financial considerations. Of course, when we don’t, we end up accumulating large deficits because part of the treatments remains unfinanced.

Then there are those institutions with oversized performance volume limits that struggle to draw down all the available funds.

They then use acute beds to treat patients even when it is not justified on professional grounds. The above examples show how paradoxical the [financial] situation is.

In which medical areas are the shortage of doctors the most acute?

On top of the list are vascular surgery, psychiatry, otorhinolaryngology, infectiology, nephrology, and orthopedic traumatology, but I could go on. Despite efforts, there is a shortage of supply, which causes serious problems. Among the reasons [for this result] are the dwindling popularity of the above fields, lower incomes and heavy workloads.

A predictable career path, higher salaries, more variety and more professional working procedures resulting from flexible training and innovative solutions, all could make these fields more attractive.

There is a need for a countrywide reform that deals with professional shortages as well. Otherwise, sooner or later we’ll face staff shortages, especially since a lot of healthcare workers will retire in the coming years. This shortage is particularly high in technical and economic fields – which is already causing more serious problems in hospitals than the reductions in the number of the nursing staff. 

The Hungarian Hospital Association have asked institutions to create a summary on the number of staff (doctors, nurses, technical and business staff) retiring in the next five years. We estimate that the number of healthcare workers will continue to drop. On a brighter note, the number of those applying to medical schools has again started to rise. This is good news, even though it will take time until these people start practicing. Equally positive is the fact that fewer doctors are leaving for [positions] abroad. In fact, many who work elsewhere do return to Hungary. This would obviously ease the labor shortage, not to mention how useful the experience that they have gained abroad will be for both them and the country.

I believe that if they are valued, paid a decent salary and provided with good working conditions, doctors would return to Hungary.

In our experience, many would be willing to accept lower salaries than in Western Europe if they were acknowledged, the equipment and conditions for treatment were available, and the general atmosphere in healthcare institutions was better.

How indebted are hospitals?

Hospitals’ deficits are near record levels, which may not come as a surprise. The lack of a financing system that is based on real costs, the high costs of new technology, medicine, innovative solutions, rising salary levels (or wage spiral in several fields), currency rate fluctuations, together with the current financing that doesn’t take amortization into consideration, all lead to hospitals with accumulating debts.

Should private healthcare be given a greater role? In what fields?

It is up to the patients. If they feel that public healthcare is not safe or accessible enough, they will continue to turn to private care. How reasonable these fears are, however, can be a topic of another discussion.