Basket | Login | Register

 
 
 
 

Regional patterns - Hungary

Cost of dementia

by Lászl´Gulácsi, PhD, Habil., Associate Professor, Krisztián Kárpáti, Assistant lecturer and Katalin Érsek, PhD student, Health Economics and technology Assesment Research Centre, Corvinus University of Budapest

Background of the "Socio-economic impact of dementia and resource utilization in Hungary" survey

To be able to correctly estimate the socio-economic impact of dementia and Alzheimer's disease, we should estimate both the welfare losses and the amounts and the value of resources devoted to dementia care.

Disease burden:

  • prevalence and incidence
  • severity distribution of the illness
  • potential of (appropriately organised) health and social services to diminish the welfare losses; or the capacity to benefit

Resource use and structure (organisation of provision and financing):

  • formal services, health services (at each level), social services
  • informal care.

As in any country, there is some existing formal health and social care system, and an informal care (family, relatives) care system in Hungary, too. In any given year the actual costs of dementia care are the costs of this formal (such as salaries) and informal care (in many cases spouse's time, mental and physical effort) system. If the formal care system costs seem to be small, we cannot conclude that the impact of dementia is small, because in that case the care resource burden is allocated to the families and some of it is visible in the welfare losses of the population.

As there are appropriate results and data about the care and resource use of dementia patients in some EU member states, the collecting of existing studies could give a complete picture about the socio-economic impact of dementia for these populations.

Since there aren’t enough valid, detailed information to appoint accurately the economic impact of dementia in Hungary, as we reported previously and as available in several EU countries. Consequently we had to perform cross-sectional survey about the patients and the caregivers among the different care settings.

We invited prestigious Hungarian experts in dementia to establish the Expert Advisory Board to prepare our data-collection and assessment. We invited researchers, physicians and active professors from the possible widest range of the involved areas.

We established our Expert Advisory Board to coordinate the survey and complete the questionnaires in 2007.

The members of the Board are various experts from their own area or speciality such as psychiatrists, neurologist, general practitioners (GP’s), pharmacist, actuary, social workers and the NGO of the patients (Hungarian Alzheimer Society). Prof. Tariska, who is a participant of the EuroCoDe project in the “Diagnosis and treatment – WP 5”, is a member of our Board, too. He, along with his colleagues helped us with completing the different versions of the questionnaires. After several mails, phone conversations and meetings we prepared different questionnaires to the different care forms, settings. There were some discussions about the right, appropriate terms, phrases and definitions in the different care forms, consequently we adopted and modified the RUD questionnaire to the individual settings, as GP and outpatient, elderly home and NGO.

Our project was a cross-sectional primary data collection process with an adopted, integrated questionnaire. The Resource Utilization in Dementia (RUD) Questionnaire, used in several international published dementia studies, was considered as a basis. We have English and a Hungarian version of RUD from Anders Wimo, the developer of the RUD. The questionnaire is divided in two parts, the first one is about the patients’ and the second one is about the caregivers’ health status and resource use. In our surveys patients’ cognitive function was measured by the Mini Mental State (MMSE) and the quality of life by the EQ-5D questionnaire.

We conducted data collection project in the different care forms, institutions. After our survey we will have data not only about cost and resource use of demented patients and their caregivers but also about their quality of life among the different disease severity as well.

Survey in different settings

We have various collaborating GP’s from the country. The GP’s work in the capital, bigger cities and smaller towns too. The physicians or their assistants helped to complete the questionnaire with the caregivers.

We had a plan and agreement to collect data with the collaboration of the Hungarian Alzheimer Society connected primarily to the caregivers and to the demented patients. The patient organization has more than 1500 members in their paper based documentation. After a controlled selection procedure, the Society promised to send 200 questionnaires to caregivers via post/letter. The leader and collaborator partner as well, of the NGO had some unpredictable event and problems after couple of discussions and finalising the adopted questionnaires. Finally the Organization didn’t send any of the questionnaires and collected any data.

One of our partners is the Ministry of Social Affairs and Labour, who helped us to complete our questionnaire in various institutions. The survey show us results of resource use from the common and specialised care home as well as departments. The adopted questionnaires were sent to six social institutions and one of them was a dementia specialised elderly home, while the other five were general elderly homes.

Background of the Hungarian health and social sectors and services

Long-term care and social care systems in Hungary

The Hungarian Health System and Social System are two independent and separate entities within the Welfare system. The nature of long-term care services includes elements from both sectors.

The Ministry for Health and Ministry of Social Affairs and Labour provide the activities and even the NHIFA (National Health Insurance Fund Administration) integrated to the Ministry of Health - is financing these services. The two sectors work isolated, but because of the parallel responsibilities, some of their tasks provisions are common. These common fields are long-term care (caring about elderly and disabled), services to homeless people, child protection and rehabilitation. As a result, the conditions for the parallel responsibilities and the connected financing is provided by both of them. (Csillik, 2006).

The services in long-term care can be divided into two parts: basic and specialised ones. The basic types are in the health sector specialised nursing care at home. The basic care services within the social sector are home help, meals on wheels, bell-alarm system, [1] administrative help and club for elderly. The specialised care forms are special nursing institutions in hospitals like special nursing departments or general chronical care departments within the hospitals[2]. The service-forms in the social sector are day care centers residential care centers for short-term and long-term housing.

Regulatory declares county governments and the governments Budapest’s districts for being responsible for providing institutional background for care.

The current situation shows parallel capacities in the health sector and in the social sector. The different nursing institutions are financed differently in the two sectors. Hungary faces several challenges in harmonizing and clarifying these factors.

It is common that people with the same needs get different help from different sectors. Some will be treated in the health sector, others will be cared in the social sector and the third part will be cared through family-provided care (Personal communication, Dózsa, 2007)

There is a shortage of data and survey results in this field.

Life expectancy and the rate of elderly citizens in the population is increasing within the Hungarian population due to several major factors. The socio-economic context has a similar pattern compared with the developed countries. However, some special factors have to be considered in Hungary as well as in other Central and Eastern European countries.

The socio-demographic context includes the following impacts on society (Iván, 2002)

  • Ageing and decreasing population
  • Decreasing number of families
  • More divorces
  • Fewer children
  • The percentage of women within the population is increasing
  • Increasing mortality among men
  • A higher occurrence of chronic diseases
  • An increasing social need because of pauperization
  • The difference among the regions of the country is increasing
  • An increase in the dispersion of chance to access health and good life quality and the risks are intensifying

Table 1: Population prognosis 2001-2050 for Hungary

Year

Population

(in 1,000)

60 years and older (in 1,000)

Age groups

0-19

20-59

60+

2001

10,200.3

2,079.2

23.1

56.5

20.4

2010

9,990.1

2,237.7

20.9

56.7

22.4

2020

9,792.5

2,536.7

20.2

53.9

25.9

2030

9,517.9

2,577.2

19.8

53.1

27.1

2040

9,158.2

2,867.7

18.9

49.8

31.3

2050

8,772.1

2,932.5

18.7

47.9

33.4

(Source: Hungarian Central Statistical Office

To mention other socio-economic context in Hungary, which lead to increased need on formal institutional care are important to note that the migration tendency is significant: the migration within the country indicates the movement of the younger generations from the small villages, towns to bigger cities within the country. This is mainly because of the centralised working opportunities. The economy is centralised and the different counties have different job opportunities. One fact is the emphasized role of the capital, the other is the relatively more intense economic life in the west region of the country

Basic care - health care sector

There are different services provided by the health care sector and financed by NHIFA, financially through the national health insurance; these are specialised home nursing, therapy services (e.g. physicotherapy) and hospice services.

Home nursing: One can receive home nursing service for free, if it’s health status requires- and the doctor recommends it. The service consists of 1 - 3 hours visit daily, during the care the patient can not receive any other public financed home treatment. The maximum number of visits is 56 per year. In case a patient requires more visits than this given amount, the therapist (with the authorization got from NHIFA) can order more (the therapist has to get authorization from NHIFA) visits.

Basic care - social care sector

Domestic care: as social basic care must be provided by all local authorities, for those people who need help for maintaining their independent conduct of life. This requirement was (in year 2003) fulfilled only in less than two-third part of the authorities, which meant 47,733 recipients (HCS 2004).

The social catering: According to the statistics in 2004 71% of the settlements is covered with this service form, which means 93% of the population in need (HCS 2005).

The homestead and village caretakers: the aim with this service is to decrease differences among villages and towns in terms of accessing social basic care. According to the Social Law Act, they work and provide care in settlements with less than 600 inhabitants in case of villages. For homesteads this number means a population of 400, who live in periphery. In that case the caretaker also plays an organizer role, even fulfils the coordinator’s task among people, institutions and authorities.

Bell alarm system [3] : is an indirect careform provided by the social sector. This social basic service has to be provided in every settlements’ local authority with more then ten thousand inhabitants. In 2004, there were approximately 6,000 caretakers who provide this service (Bácskay 2004).

For access to domestic help and the bell-alarm system social need is investigated. Health condition is proved by the GP (general practitioner). It is based on the level of dependency. On overexamination is needed at least in every two years. Without any medical opinion the provision could be resorted for only 60 days.

Daily provision and day-care center : these services have to be covered by local authorities where more than 3,000 people live, for those old people, who need help. The service was provided by roughly 1,300 clubs for about 40,500 people in year 2003.

Table 2: Number of social service users

Social basic and day care

Number of recipients

2003

2004

Domestic care (and % paying cost contribution)

43,733 (85.4%)

43,542 (85.2%)

Receiving both catering and domestic care

28,536

27,199*

Social catering (only catering)

76,238 (33,265 dining on premises or taking away, 42,973 receiving food at home)

77,311 (33,505 and 43,806 according to the same classification)*

Day care centres (number of over 60-year-olds)

40,493

39,601

Source: Social Yearbook 2004 (HCSO 2004)

* In total 104,510 recipients of catering in 2004.

Specialized care within the social sector

At first, there is a short definition for outlining that residence and care is provided in an institution to individuals in need of care, in particular in nursing homes and residential homes. Regulation diversifies two types of institutions with accommodation, the one is the nursing, caring residence and the other is the rehabilitating one.

In 2005, there were approximately 793 residences with 48,818 beds caring about 46,975 patients (HCS 2007). This number takes 2% of the elderly citizens. There are 485 beds per hundred thousand inhabitants and the occupancy rate is 96.2% (HCS 2007)

Table 4. The number of beds in the home for the aged, according to providers in 2006

Provider

Number of beds

Share (%)

Local government

16 035

32,85%

County, capital government

14 231

29,15%

Multipurpose subregion associations

249

0,51%

Central state budget institutions

50

0,10%

Public sector total

30 565

62,61%

Church

7 377

15,11%

Public services company

6 474

13,26%

Association

691

1,42%

Foundation

3 654

7,48%

Non-profit sector total

18 196

37,27%

Private enterprise

57

0,12%

Private sector total

57

0,12%

Total number of beds

48 818

100,00%

(Source: HCSO 2007[4])

There is a problematic area to mention, which is the lack of capacity. There are two main reasons for that. One is that, no institutions are available in one third of settlements. The other one is that supply is not able to complete the increasing demand (Csillik 2006).

There are special category and homes for caring about elderly needing more intense care. This type of care is provided for those who suffer from dementia, are disabled or psychiatrically, even addicted and are placed within long-term residence social institutions.

Payments for care: care allowance or care fee scene

The social sector has yearly determined amount of money, financed by the State Budget. They form different normative. These mean yearly determined amounts for the units of care: for example for beds.

According to these facts, in Hungary, social services are mainly financed by normative from the state budget, sustainability support and co-payment by the old and/or ill people. The most amounts of the costs are mainly hidden. There are no data on the number of family carers and even on their expenses, but it is estimated to be some billion HUF (around. € 8 - 9 million) (Personal consultation, Csillik 2007).

Financing the health care sector

The health-care sector (health fund by NHIFA) finances basically two types of long-term care provision: residential care which means a hospital ward (chronic or nursing ward) and home care which provides home nursing and hospice care, all of these are financed for a limited time. The hospital wards were not created for long-term care, but since there are long waiting lists to get in a nursing home (financed by social sector), and home nursing (which means 1 - 3 hours/day) in most cases is not enough, a private home nurse is not affordable for most of the families. The number of chronic and nursing beds is also limited, and the demand exceeds highly these limits.

The different types of chronic care forms get additional multiplying factor to the basic allowance determined yearly. The more intense the care is, the higher multiplying factor is determined, as it can be seen in the Table 9 and 10.

Table 9. Financing in the health sector through normative and additional factors

Name of financing category

2003
(Euro/day)

2004
(Euro /day)

2005
(Euro /day)

2006
(Euro /day)

2007
(Euro /day)

Chronic daily allowance

14

15,6

16,2

19,6

20,8

Table 10. Financing in the health sector through normative and additional factors

Multiplying factors

2003

2004

2005

2006

2007

Nursing in nursing department

0,9

1,2

1,2

1

1

Chronic care

1,2

1,5

1,5

1,2

1,2

Rehabilitation

1,5

1,6

1,6

1,2

1,2

Intensive rehabilitation

-

2,1

2,1

1,5

1,5

Hospice

1

1,5

1,5

1,5

1,5

(Source:Csillik 2007)

Considering the catering, only 9.5% of the over 70s and 5% from the 60-year-old or older population get the provision. For domestic care these figures are 3% of the 70-year-olds, and 1,4% for the over 60 population. In day care centres 4 % of the population over 70 is covered with the service. However, at the village caretakers’ service the whole capacity isn’t used.

Table 12: Comparison of the financial background in the health the social sector

Name of financing category

2003
(Euro/day)

2004
(Euro /day)

2005
(Euro /day)

2006
(Euro /day)

2007
(Euro /day)

chronic daily allowance + m ultiplying f actor in the health sector for care activity ( mf :1,2)

14,0

15,6

16,2

23,5

25,0

residential careforms' normative within the social sector, for care

7,9

8,1

8,4

8,3

7,7

(Source: personal communication Csillik 2006)

Financing the services are based in three parts in both sectors, the components are (1) provider’s subsidy, (2a) incomes calculated from performance reports in the health sector and (2b) normative determined by the actual Budget Law, and the third part is the contribution of the patient or of it’s relatives. This separation makes it more difficult to calculate the expenses either on micro or on macro level, because the changes in the share of the financing elements are not stable yet. The latest details on normative can be followed in the Table 6.

Table 7: Normative per service users in 2007

Basic services

Amount in HUF per capita

Social catering

81,200

Domestic help

111,500

Indication based domestic help

40,000

Homestead or village caretaker service

2,237,300/service

Residential care settings with accommodation

Normal service

700,000

Dement normative

800,000

Advanced service normative

350,000 + additional fund via tendering

(Source: Personal communication, Csillik 2007)

Care allowance for informal members of the long-term care system

As part of the basic social care forms it is a cash provision in Hungary: The care allowance, which is received by one of the relatives of the cared person - who do the looking after - The amount is adjusted to the minimal pension.

Thus it is worth making a comparison with the amount of cost contribution is limited in fix rate of the recipients’ total monthly income. That means the following shares of the income.

Table 8: Payment in share of income for receiving different services

Received service

Limited amount of monthly income in %

Social catering

25

Domestic care

20

Both of these

30

Day care

30

Residential care

80

(Source: Data from 1993/3 Social Law Act)

According to the latest changes of the law act the amount of the care allowance received by the family carer is 103Euros per capita per month, the advanced amount is 134Euro.

Family care

Families play an important role providing services in the health sector as well. In most hospitals there is a shortage of nurses due to the very low wages and the high fluctuation. For this reason, if a person wishes to be certain that a sick family member is receiving proper care, he or she also nurses the patient, obtains more costly and efficacious medicines not refunded by social insurance after consulting with the doctor, and – after consultation with the dietician and nurses – provides the elderly patient better quality food than that served in the hospital.

Hospitals often discharge patients without suitable rehabilitation and, at the same time, discharge patients early because of the high costs per hospital bed. The volunteers of NGOs take part in in-patient health care in the areas of mental hygiene, providing proper care for the sick (informally making up for the lack of nurses), preventing ill effects of hospitalisation and preparing patients for rehabilitation. (Szeman 2004)

The transfers connected to help adult, sick people stand in analogy with the demographical characteristics. Almost half of these supports (42%) have gone to households with 45 - 59 year-old househeads. In year 2002 there was chronic sick person is 21.5% of the households, however as few as 22.7% got help from other households (HCS 2004).

Costing of the “Socio-economic impact of dementia and resource utilization in Hungary” survey

The RUD questionnaire was used as basis for our data-collection to establish dementia patients’ and their caregivers’ resource use. With the help of the RUD the in- and outpatients visits and drug costs are measurable in the health and social sectors, too, which could be categorised and combined in the main cost categories (i.e. direct, indirect). Additionally, the productivity loss and time consumption of care are detected by the questionnaire. We supplemented the RUD with some specified and detailed questions about the specialists’ visits, transportation and drugs, as well. The additional questions were required to assess the differences because of the significant geographical inequalities in Hungary. The newest, more specific (and expensive, as well) examinations’ and techniques’ location vary in the country, with less opportunities in the eastern and north-east regions. The Dementia Centres’ location is unequal, too, which affect the finance of care and the drug reimbursement levels, as well, therefore we collected data about the “certified” dementia diagnosis.

The most up-to date databases and tariffs were used to assess the costs in the dementia care in different settings by our data. To establish the unit costs the National Health Insurance Fund’s (NHIFA), the Hungarian Central Statistical Office’s (HCSO), Ministry of Health’s (MH), Hungarian Tax and Financial Control Administration (HTFCA) and the National Institute for Strategic Health Research’s (NISHR) databases were used.

Some additional questions were about the diagnosis and symptoms were at the beginning of the questionnaire it was followed by the treatment. The possible dementia treatments’ data were collected which was defined and compiled by the Advisory Board. Drug costs were assessed by the April 2008. national and official data from the NHIFA. We calculated the total costs per mg from the financer public database. In case of missing doses we completed with the WHO DDD’s. Since there are some preparations registered as drug and available for dementia in Hungary but not registered in most of the other countries and some of drugs don’t have any WHO DDD, consequently we defined the DDD’s for these products to complete missing data. These drugs are nicergolin (ATC: C04AE02, calculated with 30mg/day) and vinpocetin (ATC: N06BX18, calculated with 30mg/day). In all the substances or drugs we used the average prices per mg from the various reimbursement categories as we didn’t have appropriate data about the financing categories. Only one drug (ATC: N06DX02, ginkgo biloba) is registered as OTC product in the Hungarian market for dementia treatment. We used the recommended retail price to assess the treatment cost. Dementia drugs’ unit costs are presented in14. Table.

14. Table Drug costs for dementia treatment in Hungary

WHO DDD (mg)

Total price/100 mg (Euro)

Average daily dose

Monthly total cost (Euro)

Monthly patients’ fee (Euro)

Most common reimbursement category for dementia

Donepezil (ATC: N06DA02)

7,5

33,09

8,9

88,4

41,7

50%

Memantine (ATC: N06DX01)

20

15,71

18,9

89,1

42,1

50%

Rivastigmine (ATC: N06DA03)

9

34,39

9,8

101,1

45,0

50%

Vinpocetin(ATC: N06BX18)

30*

0,46

22,3

3,1

1,2

55%

Nicergolin(ATC: C04AE02)

30*

1,13

33

11,2

7,6

25%

Piracetam (ATC: N06BX03)

2400

0,008

2260

5,7

3,9

25%

Ginkgo biloba (ATC: N06DX02)

120

0,58

100

17,5

17,5

0%

Selegilin (ATC: N04BD01)

5

3,93

12,5

14,7

3,0

25%

Vitamin E (ATC: A11HA03)

200

0,04

194,4

2,3

0,6

0%

*: WHO not stated DDD

Additional information about drug therapies for dementia patients in Hungary

There are 76 licensed or designated Dementia Centres in Hungary in 2008 and psychiatrists and neurologists of them are allowed to order the cholinesterase inhibitors (donepezil, rivastigmine) and memantine under reimbursement (50%). Because of the inequalities of the Centre’s geographical location there are some regions and areas, where the diagnosed and certified numbers of patients are much lower than in other areas.

Similarly to the Western European or more developed countries the cholinesterase inhibitors (donepezil – Aricept® and rivastigmine - Exelon®) and memantine (Ebixa®) are available in Hungary. The current reimbursement rate is 50% for the certified dementia patients, the certification derives from the Dementia Centre’s neurologists or psychologists. The cholinesterase inhibitors can be ordered for mild or moderate demented patients with MMSE between 10-26 (ICD-10: G30.9), if their MMSE score decreasing haven’t reached 3 points in the last 12 months. Memantine can be ordered for moderate or severe demented patients (ICD-10: G30.9) with MMSE under 20 points. For all of other patients these drugs are available for full price, without any reimbursement. The availability of these treatments are very limited for most of the demented patients in Hungary as a consequence of the high prices. With the 50% reimbursement of these innovative drugs the fees for the patients or their family are significant (more than 40Euros per month, 10-15% of the average pension) and it limits the access to these therapies. Some of the patients couldn’t reach the Dementia Centre and doesn’t get the allowance for the reduced price, too.

Piracetam was a common, widely prescribed drug in dementia in Hungary as well, with lots of generics on the market. The reimbursement of these products decreased to 25% in the last years, therefore the consumption are under the preferable, recently. These drugs are available with this reimbursement for all of the patients with diagnoses of the authorised indications.

Selegilin is a widely use drug in Hungary, because of the Hungarian relation of the development of the substance. The reimbursement of selegilin is 25% for most of the patients, with 90% it is available in Parkinson disease only.

The Vitamin-E (tocoferol) is another internationally accepted drug in the treatment of dementia despite it isn’t reimbursed in any categories or diseases in Hungary.

Ginkgo biloba is in the same situation as the E-vitamin, i.e. not reimbursed in Hungary and the monthly costs is 4,5-5Euros (only one product registered as medicine on the market).

Nicergoline is registered for the treatment of cognitive impairments and symptoms so it could be used n some demented patients, too. The reimbursement of nicergoline is 25%, consequently the monthly fee is around 6-7Euros for a patient.

There is one more drug for the dementia therapies in Hungary, which aren’t on the most markets or European countries. This is the vinpocetin (ATC: N06BX18) which is available in some countries as nutritional supplement. Vinpocetin is an old Hungarian drug licensed for vascular dementia and other cerebrovascular or circulatory problems. The reimbursement is higher for vinpocetin as other dementia treatments, it is 55% for all prescriptions. The monthly cost of this drug is less than 2Euros, consequently it is one of the widest prescribed and used drug in a lot of cognitive disorders in Hungary.

To establish the GP visit cost the last available data (2005. NISHR) were used with an extrapolation. The annual total budget of this service, financed by the NHIFA, were divided with the total number of annual GP visits and the assumable visit cost was 3,7Euros (925HUF). As the annual average number of GP visits were 11,4 in the outpatient settings with 42,18Euros while these were in 2,7 in the elderly homes with 9,99Euros.

For the specialists’ visits we used an average fee, independently from the speciality, due to the limited, aggregated data about these services. The annual total budget of these services, financed by the NHIFA, were divided with the total number of annual specialists’ visits and the assumable visit cost was 7,81Euros (1.953HUF). The annual specialists’ visits number was 5,9 in the outpatient settings, 46,09Euros and it was 0,44 in the elderly homes, 3,44Euros.

We collected some dementia specific examinations’ usage in both of the patient groups. These processes are financed on an outpatient “German point” system by the insurer. All of the available services are listed in the official tariff (or point) list, separately the different techniques and methods. Where more possible services and examinations are available we calculated the average “German points” before the multiplication with the unit cost of one point (1,435HUF – 0,00574Euro). The observed examinations are in the 15. Table.

15. Table Specialists’ examinations in dementia patients in our surveys

Examination

“German Point”

Unit cost (Euro/examin.)

Cranial CT

11.952

68,60

Cranial MR

31.462

180,59

Carotid U.S.

944

5,42

Laboratory examination

173

0,99

EEG

1.275

7,32

Psycho-diagnostic

891

5,12

The inpatient care and services are financed in a DRG system in Hungary, but in most of cases DRG code of received services aren’t available neither for the physicians nor the patients. In the patient documentation the ICD codes are presented, consequently we collected this type of data to make our assessments. All of the available services are listed in the official tariff (or point) list, separately the different techniques and methods, financed by the NHIFA. This resulted in some complication at the establishment of the various unit costs, but where more codes or treatment were available we used the average of them, the unit cost of one DGR point (146.000HUF – 584Euros).

We calculated the patients’ transportation cost by the distance between the care institution and the residential home. We calculated the kilometre unit costs in the different transportation forms (i.e.: patient transportation service, support service’s vehicle and car). In these cases the cost of one kilometre was 0,138Euro (34,5HUF) as stated in the official tariff list of the Hungarian Tax and Financial Control Administration. Ambulance unit cost (per kilometre) was calculated from the separated NHIFA budget, the annual budget of this service were divided with the total annually achieved kilometres and the assumable cost was 2,42Euros/km (604HUF/km). The average distance between the residential home and the specialists’ or GP’s institute was 24,96km in our survey. For public transportation two tickets (price in the capitol, Budapest was 0,92Euro – 230HUF per each) were calculated to visit the specialist or GP.

As unit cost of remedial gymnasts, social workers psychologists and other social workers were used the national average income. We used the 2007 gross wage data amended with all of the taxes and affixes paid by either employee or employer. Monthly gross wage was 740,02Euros (4,35/hour) and the total staff cost was 992,80Euros (5,84/hour) in Hungary, in 2007. The same method and costs were used at the productivity loss assessment for the caregivers, too.

omestead or village caretakers’ and domestic cares’ or helps’ unit costs were calculated by the annual normative for these services paid by the financer, the Ministry of Social Affairs and Labour. The cost was 12,2Euros (3.050HUF/visit) for this services. Social caterings’ tariff derived from the same database with the same method and the value was 0,89Euro per hour (222HUF/hour). While other services provided by the social sector was calculated with the national average wages, as presented previously.

Other person’s paid help was calculated with the original data from the questionnaire.

We used the same costs for resource use calculations for both of the patients’ and their caregivers’ in the case of the identical questions or items (i.e.: time consumption, productivity loss, in- and outpatient services). We calculated with the national average income from 2007. to establish productivity loss due to the care giving (“cut down in working hours”) for the informal caregivers.

The prices were calculated in Hungarian Forint (HUF) and converted to Euro (1Euro/250HUF).

List of the referred publications

Reference list of the “Background of the Hungarian health and social sectors and services”

  1. Bácskay, Andrea: Social care of elderly (Az id?sek szociális gondozása), Hungarian Central Statistical Office, Budapest, 2004
  2. Egervári, Ágnes Dr.: Homogén Gondozási Csoportok, a “HGCS” in: Szociális Menedzser (Care Related Groups „CRG” in: Social Manager 2007/1)
  3. Heged?s, Katalin, Dr.: Publication about Hospice care and directions for developments Hungarian Hospice-Palliative Foundation, 2005.
  4. GKI Economic Research Co.: Connection between social providing system and employment, Budapest 2008
  5. Hungarian Central Statistical Office: Hungarian Health Statistic Yearbook, 2007, Budapest, 2006.
  6. Hungarian Central Statistical Office: Statistical Yearbook for welfare Statistics 2005, Budapest, 2006.
  7. Hungarian Central Statistical Office: Statistical Yearbook for welfare Statistics 2004, Budapest, 2005.
  8. Hungarian Central Statistical Office: Elderly in Hungary (Id?skorúak Magyarországon), Budapest, 2004.
  9. Hungarian Central Statistical Office: Statistical Yearbook for welfare Statistics 2002, Budapest, 2003.
  10. Hungarian Central Statistical Office: The given and received transfers between households. Budapest 2004
  11. Iván, László (2002) A magyar népesség id?södésének kérdései és kihívásai, (The questions and challenges in connection with the ageing of the Hungarian population) In: Kulin F. (szerk.), Kölcsey Füzetek, a Kölcsey Intézet Kiadványa, 2002.
  12. http://www.mindentudas.hu/ivan/20040503ivan.html (27 February 2008)
  13. Nárai, Márta: The role of civil society on social services, in: Civil World, 2003., p.117-120.
  14. Cziráki, Andrea: Renewal of the social providing system. In: Szociális Menedzser: 2007/1, p. 2-9.
  15. Szémán, Zsuzsa, Dr.: EUROFAMCARE, National Background Report for Hungary, 2004.

Personal communication with experts

  1. Csillik, Gabriella, expert, Ministry for Social Affairs and Labour, 2006, 2007
  2. Dózsa, Csaba (health economist expert) 6 February, 2007

Reference list of the “Socio-economic impact of dementia and resource utilization in Hungary” survey

  1. Banerjee, S., et al., Quality of life in dementia: more than just cognition. An analysis of associations with quality of life in dementia. J Neurol Neurosurg Psychiatry, 2006. 77 (2): p. 146-8.
  2. Colvez, A., et al., Health status and work burden of Alzheimer patients' informal caregivers: comparisons of five different care programs in the European Union. Health Policy, 2002. 60 (3): p. 219-33.
  3. Ekman, M., et al., Health utilities in mild cognitive impairment and dementia: a population study in Sweden. Int J Geriatr Psychiatry, 2007. 22 (7): p. 649-55.
  4. Jonsson, L., et al., Determinants of costs of care for patients with Alzheimer's disease. Int J Geriatr Psychiatry, 2006. 21 (5): p. 449-59.
  5. McDaid, D., Estimating the costs of informal care for people with Alzheimer's disease: methodological and practical challenges. Int J Geriatr Psychiatry, 2001. 16 (4): p. 400-5.
  6. Nordberg, G., et al., The amount of informal and formal care among non-demented and demented elderly persons-results from a Swedish population-based study. Int J Geriatr Psychiatry, 2005. 20 (9): p. 862-71.
  7. Nordberg, G., et al., Time use and costs of institutionalised elderly persons with or without dementia: results from the Nordanstig cohort in the Kungsholmen Project--a population based study in Sweden. Int J Geriatr Psychiatry, 2007. 22 (7): p. 639-48.
  8. Porzsolt, F., et al., A new instrument to describe indicators of well-being in old-old patients with severe dementia--the Vienna List. Health Qual Life Outcomes, 2004. 2 : p. 10.
  9. Sicras, A., et al., Prevalence, resource utilization and costs of vascular dementia compared to Alzheimer's dementia in a population setting. Dement Geriatr Cogn Disord, 2005. 19 (5-6): p. 305-15.
  10. Smith, S.C., et al., Measurement of health-related quality of life for people with dementia: development of a new instrument (DEMQOL) and an evaluation of current methodology. Health Technol Assess, 2005. 9 (10): p. 1-93, iii-iv.
  11. Wimo, A. and G. Nordberg, Validity and reliability of assessments of time. Comparisons of direct observations and estimates of time by the use of the resource utilization in dementia (RUD)-instrument. Arch Gerontol Geriatr, 2007. 44 (1): p. 71-81.
  12. Zencir, M., et al., Cost of Alzheimer's disease in a developing country setting. Int J Geriatr Psychiatry, 2005. 20 (7): p. 616-22.
  13. Wimo A, W.A., Mastey V,Winblad B., Evaluation of the healthcare resource utilisation and caregiver time in antidementia drug trials. , in The Health Economis of Dementia , B.J. A. Wimo, G. Karlsson and B. Winblad., Editor. 1998, John Wiley & Sons Ltd.: Chichester. p. 217-230.
  14. Szende, A. and R. Nemeth, [Health-related quality of life of the Hungarian population]. Orv Hetil, 2003. 144 (34): p. 1667-74.

[1] This is a basic care form, when the availibility to the service is provided all time. The care is provided on-demand, in case of crisis. Usually a few settlements are supplied by one caretaker.

[2] This beds are not specially for elderly citizens, but mainly for patients with the need for chronic care, f.e. for those transferred from acute departments to these nursing departments. They provide rehabilitation, nursing care and hospice care

[3] HCS terminology: “Indicator based home help”

[4] Calculated from HCSO information, Yearbook of welfare statistics, 2006, table 8.10, p.83.

 

 
 

Last Updated: jeudi 08 octobre 2009

 

 
  • Acknowledgements

    The EuroCoDe project received financial support from the European Commission. Neither the European Commission nor any person acting on its behalf is responsible for any use that might be made of the following information. Alzheimer Europe also gratefully acknowledges the support it received from Fondation Médéric Alzheimer for this project.
  • European Union
  • Fondation Médéric Alzheimer
 
 

Options

  • Send this page to a friend