Dr Ildikó Horvath, Hungary’s State Secretary for Health explains her role and shares insights on the key health trends in Hungary, the government’s top priority in improving healthcare, the importance of digitalization, and efforts made to close the life expectancy gap with Europe.
Hungary is on average five years behind the EU average regarding life expectancy
Can you introduce yourself and the role of the Minister of State Health?
I am an alumna of the Semmelweis University and conducted research at the National Institute of Health (NIH) in Bethesda, In the USA in the field of blood circulation. However, I moved out of this field and combined research, education, and clinical practice in pulmonology. Thereafter, this allowed me to be active in international roles as an advisor for the European Commission in the Scientific Panel for Health and as Council Head at the European Respiratory Society. From 2010 to 2014, I served as Department Head of Health Policy and since 2018 I am appointed as the Minister of State for Health.
The role as State Secretary for Health is fulfilling, as it allows to make a direct contribution to the health of the nation. However, it requires extensive collaboration and exchanges with the other Ministries of the government. Through communication and planning, the government can achieve incremental changes in policies that can benefit the healthcare ecosystem.
What are the most significant health trends in Hungary and what are the government’s top priorities?
Hungary is on average five years behind the EU average regarding life expectancy. Albeit this result, both life expectancy and healthy life expectancy is increasing in the country faster than the EU average. The top priority of this administration is to close the gap with other European countries. In its attempt, there are areas where the government is proficient whereas others leave some room for improvement. Hungary has a nearly a 100 percent vaccination rate for all children, and this is due to an established mandatory system implemented several decades ago. Additionally, special nurses visit schools throughout the country and vaccinate children to ensure that everyone is safe. They have a mandate to help increase health literacy by, for instance, accompanying pregnant women and educating them, as well as the wider population, about the dangers of smoking beside explaining the importance of vaccination. Inadvertently, when there were outbreaks of measles recently in neighbouring European countries, Hungary was left unscathed and was an “island of safety” amidst these outbreaks.
The digital health arena is a novel and advantageous development for Hungary, its patients, and the healthcare professionals. All public sector stakeholders must provide all data and information regarding their patients to a centralized database. This can vary from when a patient receives treatment, relevant laboratory findings, and if they receive healthcare. From July 1st, 2020 privately held companies and institutions will have to comply as well, by providing their dataset as to have a more complete picture. This will drastically increase the efficacy of the e-prescription system that is in place, as physicians will have access to more complete information.
What were the factors of success that made the transition to a digitalization so smooth?
Behind this project, there was extensive planning and tremendous commitment of the government. At the heart of it, there was a close collaboration between information technology experts and the State Health Care Centre (AEEK) who oversees all hospitals. They spent a better half of the year understanding the needs and wants of patients and physicians. Furthermore, once the system was launched there was a grace period of a year, to allow elderly people and those accustomed to the old system to adapt and have time to switch over.
What are the main health challenges that are contributing to the life expectancy gap?
One of the major contributors is preventable deaths, which are twice as high as Europe. This is related to lifestyle, an amalgamation of bad habits such as excessive smoking, drinking, and unhealthy eating. Inadvertently, these factors are major contributors to cardiovascular and oncological diseases: the two leading causes of deaths in Hungary. A priority of this administration is to prevent what is preventable. Childhood vaccination is an area that the country performs well in, and with the same rigour, child obesity must be tackled. In the region, these numbers are increasing yet Hungary managed to keep child obesity rates stagnant. A rigid system was put in place, with stark policies, that would standardize efforts to curb this issue. Increased focus on physical exercise and balance of calorie intake, are factors that are helping to curb this issue.
What is the government doing to increase awareness of healthcare prevention and early detection?
The government has a flagship program called “Three Generations in Health”. It was launched as a pilot program for 17 small villages and towns. It served health prevention and promotion, as well as screening and early detection of diseases. The methodology was provided by the national institutes (e.g. National Methodological Centre for Smoking Cessation, National Institute of Pulmonology) to the community leaders, and the results were very positive.
After taking office, the idea was to replicate this and launch this for GPs and primary care employees. In Hungary, there are micro-practices, where there are one GP and one nurse, which is a typical arrangement in Hungary. This is problematic, as it burdens the medical practitioners and leaves no time to interact with the patients. The government invested HUF ten billion (USD 33.5 million) to launch the program, where five GPs collaborate with one of the 112 Health Promotion Offices in the country and collaborate with the specialized nurses, special services, outpatient clinics and local hospitals. These promotion offices adapt to the different needs of the cities. Primary healthcare is linked better than it was before, as these practices are now economically sustainable providing wider package of services to the people living in their area. As of today, there are 143 of these practice communities reaching over a million of Hungarian people. The next step will be to scale it up and reach the remaining population.
What do you see as the role of industries players when it comes to health outcomes and the opportunities that arise between their collaboration with authorities?
Industry players play a vital role and clinical research is a good example of that. Their innovations allow new drugs to reach 14,000 patients in clinical trials and the market early. Obviously, a lot of interactions exist between the industry and the authorities as it is in everyone’s interest to facilitate patients access to medicine. However, areas such as pricing is an area of contention, as we are trying to find ways to make it mutually beneficial with the current legislature and regulatory frameworks. As mentioned, in Hungary only incremental changes happen, as it requires the involvement of several authorities and ministries when making decisions. Fair and affordable, is the guiding mantra and the government is striving towards that. The principle of drug development is that innovative drug producers receive a timeslot by law for the new products, when they are sole proprietor under the condition that it is accessible to patients. Getting enough money to pay for expensive innovative drugs and make it accessible to patients, would require either a European or global solution.
What is your vision of the Hungarian healthcare system in the near future?
Healthcare needs are changing, and the government must be adaptive to these trends. As a collective administration, a balance needs to be struck between flexibility and sustainability, while being accountable for the long-term quality of the results. More attention needs to be given to patients’ response as their feedback is invaluable. Through transparency with patients and receptiveness of their input, it will allow us to identify and target areas that need improvement.