EuroHope project: Correlation between funding and excellence in health care

I often start my posts with a reference to the incredible number of articles that appeared in the Hungarian media on the topic of my choice for the day. Well, this time I was met with deafening silence when I tried to locate material on the findings of the EuroHope (European Health-care Outcomes, Performance, and Efficiency) project that compared, over three years, the quality and cost of hospital care in Finland, Hungary, the Netherlands, Norway, Scotland, Sweden, and certain provinces in Italy. The researchers focused on care for five medical conditions–heart attacks, strokes, hip fractures, very premature infants, and certain forms of breast cancer. Of the seven countries, “Hungary fared worst for most health outcomes, largely due to economic factors,” as reported by The Lancet.

The findings of EuroHope were released more than a year ago, on April 4, 2014. A detailed ranking of the countries by type of illness has been available on the website of EuroHope for at least a year, but for some strange reason the devastating news about the state of Hungarian hospital care didn’t reach Hungary until now.

To demonstrate how grave the situation is in Hungary in comparison to the other six countries, let me quote from the abstract of an article by A. Malmivaara et al. that appeared in February in the European Journal of Neurology.

In all, 64,170 patients with a disease code for ischaemic stroke were identified. The number of patients registered per 100,000 European standard population ranged from 77 in Scotland to 407 in Hungary. Large differences were observed in medication use. The age- and sex-adjusted all-cause case fatality amongst hospitalized patients at 1 year from stroke was highest in Hungary at 31.0% (95% confidence interval 30.5-31.5). Regional differences in age- and sex-adjusted 1-year case fatality within countries were largest in Hungary (range 23.6%-37.6%) and smallest in the Netherlands (20.5%-27.3%).

I find it curious that for more than a year one could learn nothing about these devastating results in the Hungarian media. Moreover, when on June 28, 2015 Válasz came out with an article titled “Little money, great death: the end of a Hungarian legend,” nobody felt compelled to pick up the story. Naturally, the government wasn’t going to rush to comment, but even MSZP, LMP, Együtt, and PM acted as if they had never heard of the findings of EuroHope. It was only DK’s medical expert, former hospital director Imre László, who bothered to send his party’s reaction to MTI, in which he claimed not only that the money allocated to heath care is inadequate but that it is badly spent.

What legend was Válasz referring to? The Hungarian medical profession claims that, although not enough money is spent on health care, Hungarian doctors are well prepared, which makes up for the material deficiencies. Válasz countered that if that were the case, there wouldn’t be such a huge difference in the numbers of Scottish and Hungarian stroke patients.

The Hungarian statistics are no better when it comes to heart attacks, which Válasz calls tragic. In Hungary 18% of the patients die within 30 days after a heart attack, while in Scotland it is 12% and in Norway only 6%. So, if you are unlucky enough to live in Hungary, your chances of dying shortly after a heart attack is three times greater than if you lived in Norway.

Rate of death after cardiac catheterization

Rate of deaths after cardiac catheterization

In brief, Hungary was dead last when it came to the mortality rates of stroke and heart attack victims and next to last in the other three categories: hip fractures, very premature infants, and certain forms of breast cancer. Nothing to brag about.

It didn’t take long for the Hungarian medical profession and even the government to respond, although the government made no public statement. Instead, the undersecretary’s office sent a letter to the editors of Válasz in which they outlined all the plans the ministry has prepared to remedy the situation. Péter Ofner, directior general of the György Gottsegen, Országos Kardiológiai Intézet, went public. He held an extraordinary press conference and released a statement in which he and his colleagues basically argued that EuroHope’s numbers are outdated. According to a statement at the 2013 Congress of the European Society of Cardiology, the difference between the Swedish and Hungarian statistics is small, 7.9% v. 9.5%, and even that can be explained away by the fact that Hungarian patients also suffered from other diseases in addition to their heart attack. So, no matter what EuroHope says, Hungarian medical care matches the best in Europe by now.

Tibor Ertl, an expert in neonatology, explained some of the reasons for the poor showing, among them the “societal roots” of the high number of premature babies, an insufficient number of nurses, hospitals not following strict rules, and of course the shortage of funds.

In addition to this lone article in Válasz, I heard an interview with Jenő Rácz, former minister of health in the Medgyessy government. Despite having been a member of the socialist-liberal government, his public appearances since he left office leave no doubt that Rácz’s sympathies lie with Fidesz.

Rácz, like his cardiologist colleagues, refused to admit that the poor performance of the Hungarian medical profession had anything to do with a lack of funds or professional competence. He didn’t deny the veracity of the statistics, but he attributed the poor results to an unfair comparison. To compare Hungary to highly developed, rich countries like Sweden, Norway, and Finland is simply not fair. Rácz didn’t mention Scotland, and he disregarded the fact that the goal of the research was to find out to what extent the amount of money spent on health care influences outcomes. He also stressed that the data is from 2008 and 2009 and since the government has spent a great deal of money to improve the situation.

Rácz’s other argument was that the Hungarian population is a great deal sicker than the populations of the other nations in this study, and therefore any comparison is inherently misleading. One physician after the other claims that patients are largely responsible for this state of affairs. They don’t take their medications, their diet is a disaster, they don’t exercise enough, and they smoke more than people in other European countries. But I think that the government and the medical profession must bear a great deal of responsibility for the fact that basic medical information fails to reach the population. I am always astonished at how ignorant even college-educated people in Hungary are when it comes to health issues.

However sobering this study is, I don’t think it will have much effect on the quality of Hungarian health care. When only recently a relative of mine, a retired physician himself, had to wait three months for the results of a prostate biopsy, one cannot expect better outcomes.

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July 14, 2015 6:14 pm
While I believe that comparing apples and oranges is an exciting exercise I tend to agree with those Hungarian health experts who blame, among others, the population for the bad “results” obtained by Hungary in such a survey. Hungary is not Sweden. Nor is it Finland, Norway or Scotland. Or, for that matter, Italy. Hungary is Hungary, where traditional cuisine is based on extremely unhealthy foods (I am thinking especially of sugar, flour and processed foods, not necessarily animal fat!) and the population is not aware of the health risks of a sedentary lifestyle. Ask a Norwegian or a Dutch whether they had a herring or some other kind of fish in the past one week or so, and they will likely say yes. Ask a Hungarian and they will answer that they haven’t eaten fish in years. Ask a Swede whether they do regular sports and they will likely answer that they exercise several times a week; a Hungarian will tell you that they sat on a bicycle decades ago or that the last hike they remembered was a high school outing to Normafa (which they reached by cogwheel train from János Kórház, which they reached by tram, which… Read more »
July 14, 2015 8:06 pm

It is you who compares apples to oranges. You are mixing up different things here. The EuroHope study is NOT about incident rates of the leading killer diseases. It is looking at ONCE the incident occurred, what are your chances to recover which is completely independent of the incident rates.

So don’t try to do hogwash this situation like leading Hungarian health care leaders do. The published data precisely qualify the status of Hungarian health care and nothing else.

I might say epidemiology and interpretation of epidemiological data do also not seem to be a strong suit of the Hungarian health care leaders.

July 14, 2015 7:05 pm

You know the data on survival rates after heart attack isn’t too enthralling. It would appear to me that interventional cardiologists perhaps are at a premium in Hungary or the after-care is sub-par. Why? I’d think allocation of money and resources has to be a main consideration of the government at the least when it comes to providing quality health care. We know health care is expensive.

Question is is the government doing its best along those lines for the country’s current and future population when it comes to providing the best health care for its citizens? Or is it perhaps operating like Steve Martin’s ‘ Theodoric of York’ in that old Saturday Night Live ‘Medieval Barber’ skit? Theodoric, if some may know, thought himself top of the line in health care. ‘Barbers’ at that time were the greats in ‘medicine’. He loved to issue his usual prescription: bloodletting for the ill population of York..;-)…

July 14, 2015 8:47 pm

“the data is from 2008 and 2009”? And what about some more neighbouring states as controls?

July 14, 2015 11:17 pm

I have gotten sick twice while on 4 week visits to Hungary. Never have my friends suggested going to a doctor. That was for my return home, where anti-biotics cured my sicknesses. Even when I suggested that a doctor might help, silence was the answer. I view this as absolute lack of trust.

July 15, 2015 12:21 am

What happened in Hungary in the first quarter of 2015? The ratio of deaths surged to a 70 year old number, not heard of since the second world war. After the numbers were published by the official Statistical Office, newspapers and officials vaguely blamed the horrible number on some kind of, not specified epidemic – not the sorry state of health care & a deliberate Taygetos for the old to decrease the social security expenditure.

If there was indeed a mysterious epidemic, it shows the lack of free and vigorous media in Hungary. No newspapers discovered this epidemic during the first quarter. No newspapers demanded the name of the alleged epidemic since then.

1st quarter deaths in Hungary

2011: 35109
2012: 35797
2013: 33944
2014: 32988
2015: 38227, 10.93% above the average of the previous 4 years, 15.88% y/y.

By the way, the lowest rate of mortality in Hungary was in the 1955-1967 period.

July 15, 2015 11:05 am

Probably both are true at the same time. The quality of health services and the health condition of the people are both terrible.

(But there are now good-quality private health-care clinics, at least in Budapest, which provide completely legal, Western quality service for the amount one would anyway have to pay as hálapénz, the expected money to be paid into the pocket of the doctor).

Smoking, drinking (being an alcoholic), being fat are very common, nobody does any sports at all.

An average (!) Hungarian uses 0,8 toothbrush per year, which means that 5 million people use less than that, ie. probably buying a toothbrush only every two years.

Being health-conscious is regarded as feminine/gay, rural people (that is everybody outside Budapest) would never attempt to be either.

July 15, 2015 8:04 am

“Right to be Forgotten”.

Between May 29, 2014 and March 23, 2015,
Google received 218,320 European requests for making links unavailable at searching.

It granted 46% of the requests, rejected 38% of then, while the rest was under review.

In the public figure and political categories, it granted only around 22% of the requests.

Google granted 816 private personal requests from Hungary out of 1936. It also received 179 requests in the “public figure”, 53 from the “political” and 30 from the unclear “cp” category.

July 15, 2015 12:43 pm

Re: “Being health-conscious is regarded as feminine/gay, rural people (that is everybody outside Budapest) would never attempt to be either”

Maybe Viktor should get up on the stump and get time on all his stations and do a 10 minute so-called ‘infomercial’ piece on how his wife makes ‘low fat’ paprikas csirke or gulyas for him?? I minute to make the statement and then 9 to explain what ‘low fat’ means. A selling job. But of course he is apparently a great salesman, isn’t he? Here in the States usually the job of doing something like that goes to celebrities. A ‘name’ is incredible for recognition and acceptance!

July 15, 2015 2:24 pm
(nothing ever quite OT when it comes to OV…) LGBT Rights: Canary in the Mineshaft “Marriage” (as opposed to civil contracts), and especially its overlay of fideist fanfare and flim-flam, has always struck me as silly, irrespective of what genders are involved. But it has also always seemed obvious that there should be an equal right to engage in such silliness, irrespective of what genders are involved. So I (always slow on the uptake) only started to realize the importance and significance of the LGBT rights movement when I noticed who was opposing it: For, virtually without exception, those who opposed LGBT rights were the very same ones who opposed all or most of what I (and, I think, most decent people) take to be fair and right. So here’s Hungary’s Jobbik, a party that embodies and celebrates all the uglier sides of human nature — ethnocentrism, racism, sexism, brutality, violence — putting on a “charm campaign” in Washington to try to make itself look electable to more than just the tail end of the normal curve. There is an important article in the Hungarian Free Press about the Jobbik/Fidesz “charm campaign” in Washington: “” “Tad Stahnke: Don’t be duped… Read more »
July 15, 2015 2:41 pm