1. 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 first ENQual workshop NIVEL, Utrecht 28 December, 2003

2. 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) HunHTAUnit of Health Economics and Health Technology Assessment

3. 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 HunHTAUnit of Health Economics and Health Technology Assessment

4. 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. HunHTAUnit of Health Economics and Health Technology Assessment

5. 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 HunHTAUnit of Health Economics and Health Technology Assessment

6. 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. HunHTAUnit of Health Economics and Health Technology Assessment

7. 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. HunHTAUnit of Health Economics and Health Technology Assessment

8. Quality management/improvement systems • ISO : 9000-20000 • EFQM • Hospital Accreditation Standards (JCI) Certification only! (accreditation is only for labs, no hospital accreditation body) HunHTAUnit of Health Economics and Health Technology Assessment

9. ISO : 9000:20000 Wide diffusion of the ISO:9000:2000 standards 64 hospitals from the 164 (all departments – total hospitals are certified) Manual for ISO implementation, 2003 (Ministry of Health – www.eszcsm.hu) HunHTAUnit of Health Economics and Health Technology Assessment

10. Hospital Accreditation Standards JCI adaptation Certification (NOT accreditation) 8 hospitals (from the total number of 164) HunHTAUnit of Health Economics and Health Technology Assessment

11. EFQM Self assessment is used by 10% of the hospitals HunHTAUnit of Health Economics and Health Technology Assessment

12. Quality improvement activities and results Practice guidelines 18 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 Health 37 indicatorswere 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) HunHTAUnit of Health Economics and Health Technology Assessment

13. Quality improvement activities and results Indicators / National Health Insurance Fund Indicator setting based on already existing database (hospital performance) and beingused 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 HunHTAUnit of Health Economics and Health Technology Assessment

14. 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 HunHTAUnit of Health Economics and Health Technology Assessment

15. ENQual project Congratulation and thanks to Cordula Wagner and colleagues! Hope to learn a lot from you in the coming 18 month! Looking forward to see how the Quality Policy in health care might look like in a 25 member states European Union! HunHTAUnit of Health Economics and Health Technology Assessment

16. 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 Gulacsi 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 HunHTAUnit of Health Economics and Health Technology Assessment