Health Service in Hungary at the turn of the Millennium
Health is in deep crisis all over the world. The medical scientific and technological revolution skyrocketed health care costs in highly developed countries. Increasing automation and computerization and the time-consuming burocratic work demands led to a distancing of doctor from patient and to a growing patient dissatisfaction with a depersonalized system. In poor countries the lack of financial resources is the leading problem. The health service had always a low share from the GDP in Hungary. In addition it had to face a gradual decrease of 30-40% of real value during the last decade. The salary of doctors and health personnel is so low that the lack of nursing staff may already endanger the life of severely ill patients. The ratio between inpatient and outpatient care improved during the last decade but could be still much better if the reimbursment by the health-insurance would motivate the change. Efforts for more widespread application of preventive medicine are increasing, but the full spectrum of prevention: early diagnosis, prevention of progression of diseases and their complications, the prevention of drug resistance and early death need a lot more postgraduate education and financial support to be attained.
The signifinance of health care and its possibilites in Hungary
The concept of Health Promotion has been initiated more than a decade ago. Scientists realized that health means much more than the lack of diseases. The also discovered, that wellbeing of a given society is based only on some 20% of the National Health Service. The majority of responsibility of maintained health is task of the society, and of the individual as well. Many health promoting projects started under the umbrella of the World Health Organization (WHO), including Health Promoting Hospital program (HPH). The hospital stands in the focus of this project for here concentrates scientific and instrumental capacity, and the hospital serves as an important customer as well.
The official HPH project started in 1991, with the "Budapest Declaration", where the guidelines and tasks were summarized. The Natonal "Korányi" Institute, as the only Hungarian hospital joined to this European network, with 5 accepted subprogrammes.
By the year 1995, we started to build up the national HPH-network, and up till now, 27 hospitals joined to us. Meanwhile, due to our recommendations, the philosophy of the project changed somehow. Based on special East European conditions, we advised - symbolically - to demolish the walls of the hospital, and to open the project for the general practitioners, community, and other civil settings. This change mirrors in the local subprojects of Hungarian joined hospitals. The majority of health promoting programmes deals with screening processes against chronic non-inflammatory diseases, rehabilitation, and other health promoting activities, which contribute "to gain health"!
Main problem is still, that managers of the hospitals do not really understand, why membership in HPH is advantageous for the staff. Another difficulty is lack of centrally accepted health promoting nationwide program. Missing financial sources also block the rapid development of this concept. Our main task at present is, to convince politicians, health authorities, opinion-leaders of further health policy planning, that to promote, gain health -on a long distance- is more advantageous in reducing both the very sad Hungarian morbidity and mortality parameters, and also to spare money, than the traditional cure of the diseases.