Health care providers in Hungary have to possibility to perform one-day surgery interventions since 1997. The code list of the interventions was codified in the 9thappendix of the 9/1993. (IV.2.) Decree adopted by the Minister of Public Welfare. The goal of our research is to determine the number of one-day surgery interventions in Hungary between 1997 and 2017 according to the change of legislation during the above-mentioned period of time. The database of the research is based on the 9thappendix of the 9/1993. (IV.2.) Decree adopted by the Minister of Public Welfare, between 1997 and 2017 and it consist of the code of the intervention (WHO), the name of the intervention, the linked diagnosis related groups (DRG) and the codes and names of the main group. According to our results, 130 one-day surgeries could be performed in 1997, including cardiovascular (18) ophthalmological (18) and gynecological (18) interventions (These were the significant in the database.) By 2005, the number of one-day surgery intervention has increased to 230. The interventions included treatment of musculoskeletal system and connective tissue diseases (53) ophthalmological diseases (36) and cardiovascular diseases (29). The highest number of one-day surgery interventions made possible was in 2017, when 564 interventions were financed. A significant portion of the interventions included the treatment of musculoskeletal system and connective tissue diseases (130) and otorhinolaryngological diseases (91) and gynecological and obstetrical related issues (51). In the examined period, one can conclude, that in 2017, the number of hypothetically financed one-day surgery interventions have increased to more than its fourfold, since 1997 in Hungary. Moreover, the increase of the number of interventions affected all fields. One can highlight the significant positive increase in the field of otorhinolaryngology, orthopedics and traumatology.

The ophthalmology field has a significant impact on one-day surgery in the Hungarian health care sector. There are interventions, which have been performed in inpatient form and in one-day surgery form as well. The aim of the study was to analyse the number of interventions which were performed in inpatient and one-day surgery form, to assess which one could play a significant role in cataract waiting list reduction process in Hungary. The database of this research was provided by the National Health Administration Fund, which consist of all cataract interventions which had an obligation in Hungary to register their waiting lists between 2010-2017. We arranged our datas according to WHO codes (51460, 51470, 51471, 51474, 51475, 51574), form of the health services, case numbers, as well as reimbursement categories. According to our results, there were 546,541 cases which were provided in the above-mentioned period in Hungary. In the first year of the examined period we found that 2/3 of the cases were provided in inpatient form (35,931 cases). We have found a change in trend between 2011-2017: most of the analysed interventions were accomplished in one-day surgery form. Those interventions, which were analysed in this research (546,541 cases), more than 71% were performed in one-day surgery form (388,349 cases). According to our results 96 % of all cases were WHO 51474 interventions (523,741 cases), which were performed more than 72% in the form of one-day surgery (380,291 cases). We could identify an increasing tendency in the aspects of cataract case numbers in the examined period, nevertheless the tendency was maintained by the significant accumulation of one-day surgery cases. We could declare that one-day surgery, as a health care form could be significant in cataract waiting list reduction process in Hungary.

The foundation of the one-day surgery patient-care is that the patient cannot stay in healthcare institution longer than 24 hours. With the constant development of surgical techniques, minimal-invasive procedures come into view that creates an opportunity to quick rehabilitation. The aim of the research is to analyse the demographic indicators of patients in one-day surgery in Hungary between 2010 and 2016. Data used in the research were provided by the National Healthcare Services Centre, PULVITA Healthcare Database. The database contained data of the sex, age and address of patients in one-day surgery cases between 2010 and 2016. The case-numbers of both sex, the average age of patients as well as the case-numbers /10,000 inhabitants by county were evaluated. 1,491,416 cases were registered in the abovementioned period. In 2016 (275,920 cases), 200% more cases were performed than in the year of 2010 (130,995 cases). The majority of the patients consisted of women (69.51%). From 2010 to 2016 the number of cases with men increased by 279.78%, and slightly less with women (188.02%). The average age of men was 56.15 years and 49.93 years in the case of women in one-day surgery. The number of cases per 10,000 inhabitants also escalated greatly during the 7-year period. In 2010 the case number was 130.81 cases/10,000 inhabitants, in 2016 it was 280.73 cases/ 10,000 inhabitants in Hungary. In the aspect of counties, the number of cases/10,000 inhabitants was the highest in Tolna county in 2010 (184.16 cases/ 10,000 inhabitants), although in 2016 it was in Baranya county (386.76 cases/ 10,000 inhabitants). According to our research we can conclude that the number of cases of one-day surgery patient-care escalated in every aspect. A huge increase is seen in the overall cases nationwide, in the aspects of sex and cases per 10,000 inhabitants.

One-day surgery interventions have been increasing in Hungary in the past few years, especially among young- and middle-aged adults. The purpose of the research was to assess the performance data of Hungarian one-day surgeries among 1-17 years old patients. The database of the research was ensured by the National Health Care Services, which consists of all one-day surgery-, and inpatients cases, and weight numbers between 2010-2017. The database also contains the types of the provider health care institute, the sex of the patients, and the supplier medical fields as well. According to our results, there were 3,600 one-day surgeries in 2010, however in 2017. we could idenfity a significant increase in the aspect of case numbers (9,888 cases), which is more than 323%. In the aspect of weight numbers of performed one-day surgery interventions, we found another significant increase between 2010-2017, which is more than 502%. The total amount of one-day surgery cases and weight numbers were: 56,411 cases and 24,050 weight numbers. Most of the cases were provided by county hospitals (17,059 cases, 30% of the total cases), besides most weigh numbers were provided by the county hospitals too (6,688 weigh numbers, 28% of the total amount). Most cases and weight numbers were related to the paediatric surgery field (24% of the total cases, and 21% of the total weigh numbers). The one-day surgery interventions have been increasing among children in the examined period (both cases and weight numbers), especially in the paediatric surgery field.

Ophthalmology is one of the most significant field of one-day surgery care. In Hungary, there are dozens of ophthalmology interventions which cloud be operated in one-day surgery. The aim of our research is to assess the ophthalmology’s case numbers which had been performed in one-day surgery care between 2010-2016. Other goal of the research’s is to evaluate the rate of ophthalmology’s case numbers of the total one-day surgery’s. Our database was ensured by National Health Administration Fund, which consists of all inpatient cases as well as one-day surgery cases which had been performed in Hungary during the period of 2010-2016. During the examined period, approximately 14 million cases had been performed on inpatient form in Hungary (13643323 cases). From all inpatient cases the market share of one day surgery was 10.66 % (1454964 cases). According to our results more than half million cases were performed inpatient form which were related to ophthalmology’s field (590176 cases). From all inpatient ophthalmology case’s the market share of one-day surgery was 59.46% (350975 cases). Our results have shown that the town’s hospitals have performed the most interventions in one-day surgery between 2010-2016. The research also identified that cataract surgeries had the most significant market share from the total one-day surgery interventions which had been operated in the examined period (305386 cases). The impact of one-day surgery in Hungary is remarkable. There has been a significant increase in one-day surgery’s case numbers in the examined period. Furthermore, the ophthalmology’s field has a notable impact in Hungarian one- day surgery. Moreover, the cataract surgeries had a significant market share of all performed one-day surgery intervention.

Over the past few years one-day surgery has become more specific in the health care system throughout the world. In Hungary, the university clinical centres usually treat patients with multiple problems, but they are also interested in one-day surgery. The aim of this study is to analyze the performed one-day surgery’s number of cases of Hungarian university clinical centres between 2010-2015. Our database was ensured by National Health Administration Fund, which consists of the number of one-day surgery cases performed by Hungarian university clinical centres and it also consists of the rate of achievable and performed one-day surgery case numbers in the examined term (2010-2015). In the examined period Semmelweis University Clinical Centre performed the most number of cases (63913) in one-day surgery. It’s market share was more than 34% of all Hungarian university clinics’ performances. The other Hungarian university clinics such as the University of Szeged Albert Szent-Györgyi Health Centre counted 50766 cases (27.38 % market share), the University of Debrecen Clinical Centre counted 39182 cases (21.13 % market share) and the last one is the University of Pécs Clinical Centre with 31512 cases (16.99 % market share). The rate of the achievable and performed one-day surgery’s case number was the highest in University of Szeged Albert Szent-Györgyi Health Centre (58.36%). University of Debrecen Clinical Centre (55.26%), Semmelweis University Clinical Centre (49.40%), as well as University of Pécs Clinical Centre (44.13%) performed less than the University of Szeged Albert Szent-Györgyi Health Centre. The analyzed results have shown distinct range among performances of university clinical centres in Hungarian one-day surgery. During the examined period Semmelweis University Clinical Centre had the largest market share in performed one-day surgery interventions’, although University of Szeged Albert Szent-Györgyi Health Centre treated all its patients in the largest proportion in one-day surgery form.

Sz Szigeti, P Gaál, P Gyenes, F Farkas-Borbás, P Mihalicza, M Gresz, P Kiefer, J Vitrai, P Fadgyas-Freyler, JK Horváth, B Babarczy WHO Country Office for Hungary, Budapest, Hungary National Healthcare Service Center, Budapest, Hungary Ministry of Human Capacities, Budapest, Hungary National Health Insurance Fund Administration, Budapest, Hungary Contact: babarczy.balazs@gmail.com Issue/Problem Hungary is facing a number of important health system challenges, including in the areas of health status, equity, efficiency and quality. A significant volume of data is available on health status and healthcare, however, a systematic analysis of these is a difficult matter. The aim of the Hungarian Health System Performance Assessment (HSPA) was to institutionalise a system-level measurement cycle delivering quantitative support for policy making in health. This exercise is embedded in the international HSPA movement. Description of the problem The health system is large and diverse, and most health system goals are influenced by a great number of factors outside this system. In 2013 HSPA set out to bring diverse actors together, to define, calculate and analyse a significant number of indicators (75) based on a consensus assessment framework and to draw meaningful conclusions based on them. Results The first HSPA report was submitted in 2016, and reflects the consensus and the cooperation of a wide range of stakeholders: the Ministry of Human Capacities and its six background institutions, as well as the Central Statistical Office of Hungary. It processes data from different sources, ranging from health insurance reimbursement to national health accounts and household panel data to specific public health surveillance systems. It analyses the 75 indicators in detail, draws conclusions by thematic chapters and gives overall summaries on the state and performance of the health system. Lessons The health system operates in a complex environment, and can impact on some of its elements more than others. Keeping this in mind, eleven main performance shortcomings have been identified, along with eight overarching phenomena in the health system which probably contribute to them. Further development of the governance structure and the health information system is warranted, in order to formulate appropriate policy responses.

In Hungary, home-based parenteral nutrition has been financed by the social insurance system since January 2013. Our objective was to analyse the system of financing home-based parenteral nutrition. Data used in our analysis were taken from the financing database of the National Health Insurance Fund Administration. Period analysed included years between 2013-2015. Patients receiving home-based parenteral nutrition were assigned a code ’OENO 88744’ of International Classification of Procedures in Medicine. According to the database of the National Health Insurance Fund Administration, reimbursement was given to 53 patients since January 2013, on the basis of home-based parenteral nutrition. Thirteen patients were under 18, the oldest was 73 years old. Twenty-one organisational units from 14 institutions reported cases of home-based parenteral nutrition. Szent György Hospital of Fejér County, Szent Imre Hospital from Budapest and Semmelweis University reported 76% of the patients and 78% of the days on parenteral nutrition. Twenty-two of the patients on home-based parenteral nutrition received a Hickman catheter and 18 were inserted a central venous line. Mean reimbursed nutrition units per patient were 25/month. Out of 9736 nutrition units, 6 patients were reported to receive more than two units daily ( 490 nutrition units in total). Thirty-two of the patients on home-based parenteral nutrition were reported to have had resection of the small intestine, 11 required an ileo- or jejunostoma, and 12 had undergone small intestine surgery. The most common main diagnosis was bowel insufficiency caused by Type 1 short bowel syndrome in 46% of the cases. As the data suggest, current patient numbers in Hungary are significantly lower from what had been procrastinated to be around 100-150 according to population size by international statistics. After the possibilities of reimbursement were created, the patients received planned parenteral nutrition.

Cardiovascular diseases are one of the leading causes of mortality in Hungary. The past decade has seen significant advances in invasive cardiology in Hungary. The aim of our analysis was to determine the number of acute myocardial infarctions and crude mortality rates in Hungary. Data analysed were taken from the National Health Insurance Fund Administration financing database. The period analysed included years between 2004-2012. Patients with acute myocardial infarction were assigned codes I21 and I22 according to the International Classification of Diseases, ICD). The annual average number of patients with acute myocardial infarction was 14,545 (SD: 895.5) per year between 2004-2012. Crude mortality rates between 2004-2012 were the following. Mean 1-day mortality was 4.4 % (Min: 4.12%; Max: 5.05 %; SD: 0.31), mean 7-day mortality was 8.3 % (Min: 7.63%; Max: 9.10%; SD: 0.50). Mean 30-day mortality was 13.7 % (Min: 12.89%; Max: 14.55 %; SD: 0.50). Mean 365-day (one year) mortality was 24.6 % (Min: 23.15%; Max: 26.32 %; SD: 0.92). There was a significant increase in the number of patients that underwent cardiac catheterisation. While in 2004 only 17.4% of patients with myocardial infarction underwent cardiac catheterisation in 2012 this rate rose to 47.3 %. There were no significant changes in the frequency of occurance of myocardial infarction in Hungary between 2004-2012. One-day, 7-day, 30-day and 365-day crude mortality rates did not reveal significant changes through the examined period. Despite significant developments in the field of invasive cardiology, further steps remains to be made to decrease mortality form myocardial infarctions.

In Hungary, day surgery procedures have been performed since 2003 within a special social insurance reimbursement framework. Our aim was to analyse the rates of day surgery interventions in Hungary during the past decade. Data analysed were taken from financing database of the National Health Insurance Fund Administration. The period analysed included the years between 2004-2014. Medical procedures we defined as day surgery procedures, were those listed among interventions which can be carried out on a day surgery basis in Appendix 9. of the Ministerial Decree 9/1993. (IV.02.) on social insurance financing. Results of our analysis show, that the number of procedures that can theoretically be performed on an outpatient basis according to the law, did not change significantly in the past decade. It was around 600 000 cases annually. Out of these, 14.6% in 2004 and 43% in 2014 were actually, carried out on a day surgery basis. Examining the speciality areas, while gynaecology and ophthalmology show a continuously increasing tendency with respect to day surgery procedures, its rate reaching nearly 50%, surgery and orthopaedic surgery show a considerably low rate, under 25%. Twenty-nine per cent of the patients admitted were discharged within the first 12 hours. Nineteen per cent of patients stayed in hospital for 12-24 hours. In 52% of the cases, hospital stay exceeded 24 hours. The 10-year period investigated saw a significant increase in the number procedures carried out on a day surgery basis in Hungary. Nevertheless, this is still far behind the rate of 60-70% cited by international literature. Speciality areas of medicine also show marked differences in their tendencies to perform day surgeries.

To give an overview about the main diagnoses, age distribution, further fate of the elderly patients and its costs in emergency departments in Hungary in the past 11 years. The study based on the NHIF’s data and it is focused on the characteristics of emergency admissions of the patients over 65 years of age, highlighting the cases where 5 or more emergency admissions happened. The DRG weights have been used for estimating the costs of care. In view of the age distribution of cases, the 35-49 age group covers the highest percentage (18%), but the proportion of the over 80 years of ages and is also high (11%). Dehydration, chest pain and ethanol toxicity are the leader diagnoses in emergency units. Considering the further fate of the patients the hospitalization moderately increased, while the discharges to patients’ home were doubled. In the age groups of 65+ patients the hospitalization is remarkable. In 65+ age groups in the last 6 years we found a lot of patients who appeared more than 5 times and we found some patients who appeared more than 20 times. In the case of these patients, the main diagnoses were dehydration (32.3%), toxic effect of alcohol or ethanol (29.8%) and anaemia (11%). The use of emergency beds by people over 65 is influenced by many factors which are connected to the patient (eg.: age, health status), to the delivery system (eg.: access, the strength of primary care) or to the relationship between the providers. The high number of dehydration cases and the toxic effect of alcohol is thought provoking, which may refer to the shortcomings of the care system/s and social issues. Our first situation analysis highlights further examination opportunities, like connecting emergency admissions to other characteristics of patients or care, and the examination of avoidable emergency admissions (in particular the multiple appearances).

In 2012 the Hungarian intensive care units system was restructured. The multidiscipline intensive care units were separated from the postoperative intensive units and the one specialty intensive units. The effect of it was analyzed. Data were got from the National Health Insurance Fund Administration of the intensive care units for 10 years. There were investigated the organizational and the patient care related data. In 2012 the number of the multidiscipline intensive care units decreased 20% and the number of beds decreased 10%. Due to reorganization both the CMI and days of mechanical ventilation increased significantly in the multidiscipline intensive care units. In 2000 the 12% of the patients were discharged from the intensive care units to home, but by 2014 this rate decreased to 3%. It showed the use of the intensive care units were partially unnecessary before the reorganization. If we take the optimal bed-usage for the intensive care units to be 85%, in the new situation the actually available reimbursement approached to the theoretical value. The average bed-usage was 55% in the both period, but the statistical variance between the separated intensive care units decreased in the last years. The results shows that the reorganization was effective. Level of the intensive care have got higher, the use of the beds and the reimbursement increased. It is suggested to do similar reorganizations in the other specialties.

The Hungarian health budget does not allow all candidates to be promptly operated on with vertebral malformation. The budget is enough for approximately 4000 stabilizations by implant. The rest have to be put on the waiting list. The aim of our study is to analyse the costs related to the patients being on waiting list for surgery of vertebral malformation. Data derived from the nationwide financial database of the Hungarian National Health Insurance Fund Administration. 71 patients on waiting list of an institute in 2005-2006 were studied. We analysed the average waiting time and the costs related to patients either operated on or without operation. The average age of all candidates was 55 year and the average waiting time was 32 months. The treatment cost during the waiting time was US$ 103 per month per patient. The average age of candidates operated on was 57 years and their average waiting time was 15 months with a costs of US$ 155 per month per patients. The average age of candidates not operated on was 54 years and their average waiting time was 15 months with a cost of US$ 92 per month per patient. Half of candidates have not been operated on, because at the appointed date they postponed the operation. But they seem not to really want to be operated on. The reason could be they were not sure enough to be able to get job after the operation at their age.

To evaluate the most frequent outpatient care physiotherapy services provided for musculoskeletal and connective tissue diseases and determine the total health care expenses of them. Data were derived from the countrywide database of Hungarian Health Insurance Administration (HHIA), based on official reports of outpatient care institutes in 2008. The total numbers of different physiotherapy services were determined by selecting the reported specific diagnoses codes and counting the number treatments provided for that specific diagnosis code. The different types of treatment codes are listed in the chapter of the Guidelines of HHIA for ‘Physiotherapists, massage-therapists, conductors and other physiotherapy practices‘. The musculoskeletal and connective tissue diseases are listed in the International Classification of Diseases (ICD) with code of M00-M99. The total number of the 151 different types WHO-classified physiotherapy services was 29045736 in the year of 2008, 17455468 (60.1%) of them with the ICD code group M00-M99. The services with highest incidence are the followings: 1) ultrasound therapy 2011189 (11.52%); 2.) iontophoresis 1586016 (9.08%); 3) massage therapy with hand l946364 (5.42%); 4) middle frequency electrotherapy 932474 (5.34%); and 5) passive motion therapy on multiple limbs 821314 (4.7%). The number of the 20 most frequent types of therapies was 14285957, which is the 81.84% of all cases. The total health insurance reimbursement of the treatments of diseases with ICD code M00-M99 was 4.713 billion Hungarian Forint (18.76 million EUR). The 60.1% of the total number of physiotherapy services were provided for the treatments of diseases with ICD code M00-M99, supporting the notion that physiotherapy is dominantly used in the treatment musculoskeletal diseases. The financial cost of the outpatient care physiotherapy of diseases with ICD code M00-M99 exceeded the 50% of the total budget provided for physiotherapy services.

However, the number of disabled pensioner under and in normal retirement age has decreased in the past few years, it is still quite high. 29,8 % (2010) of the population receive pension, allowance and pension-like providing. More than one fouth of them are disabled pensioners whose 50 per cent are under the retirement age limit. This causes a considerable medical and economic problem. We have examined the alteration of the number of disabled pensioners living in Hungary in regard to sex and age distribution according to the datas of KSH. We have examined the number of the disabled pensioners in relation of total pensioners, in relation of the underaged and in normal retirement age. A total of 49.5 % of the disabled pensioners are at the normal retirement age limit. They are altogether 7.5 % of the total population. The proportion of the underaged disabled pensioners was 13.9 % on average. In the Central Hungary is 10 % of the retired population, in the region of Central Transdanubian region 11 %, in the Southern Transdanubian region 18 %, in the Northern Hungarian region 16 %, in the Northern Great Plain region 18 %, in the Southern Great Plain it is 11 % in 2010. The rate of the underaged disabled pensioners is in Tolna, Békés, Szabolcs and in Csongrád county is the highest, and int he capital and int he Western Transdanubian counties is the lowest. The gender distribution of disabled pensioners is around 50 % in every region. The large number of the disabled pensioners, especially who are under the age limit, and their proportion of the total and retired population can be explained by labour market and health conditional reasons which signifies serious health and economic problems.

To evaluate the most frequent outpatient care physiotherapy services provided for trauma patients, based on age and regional distribution. Data were derived from the countrywide database of Hungarian Health Insurance Administration (HHIA), based on official reports of outpatient care institutes. The 151 different types of treatment codes are listed in the chapter of the Guidelines of HHIA for ‘Physiotherapists, massage-therapists, conductors and other physiotherapy practices‘. Of the physiotherapeutic services provided for trauma patients, the knee and lower leg injuries (ICD code S80-89) occurred with the highest incidence. Data collected from the year 2008 were further analyzed based on the distribution among the 7 different Hungarian regions and based on age distribution, set to 5 years intervals. The total number of the provided 151 different types WHO-classified physiotherapy services was 29045736 in the year of 2008; 3188650 of them with the ICD code group S00-S99 with the highest incidence: 713898 of services for knee and lower leg injuries (S80–S89). The highest number of physiotherapy treatment in total of 86048 cases was provided for patients in the age group 30 to 34, followed by age group of 35 to 39 with 77903 cases. The average number of cases was 71.17/1000 persons. Injuries related treatments occurred with the highest incidence in the Central-Hungarian region (81.07 cases/1000 population) and with the lowest incidence in the Western-Transdanubian region (62.52 cases/1000 population). In case of the traumatic injuries, the highest demand of the outpatient care physiotherapy services occurred for knee and lower leg injured patients. The differences of the incidences (calculated per 1000 persons) in the regional distributions require further studies.

The resetting the clock was introduced at the beginning of the last century in Hungary. Since then it has been maintained almost continually. Energy-saving has been the aim of the resetting the clock. The question is what the effect of the spring and fall time-shift for the human body is, how the human body can tolerate the effect of the spring and fall resetting the clock. The data of the National Health Insurance Fund Administration were summarized from 1999 to 2011. That included 83 million out-patient and 2.7 million inpatient cases. The BNO main diagnoses of the week before resetting the clock were compared to the main diagnoses of the week after resetting the clock. The number of the out-patient cases decreased after resetting the clock. The number of the in-patient cases increased after both, the spring end the autumn resetting the clock. The highest increased was showed in the psychiatric patients. After resetting the clock, on Monday, the number of the hospitalized patients doubled. The psychiatric diagnoses, using the BNO code system, were 3.8-fold, the diseases, related to circulatory system was 1.9-fold and the traumatological cases were 1.5-fold after resetting the clock. The economical benefit of resetting the clock can be questioned in the view of the plus 53,000 hospitalized patients (14,000 more circulatory, 10,000 more psychiatric and 3,000 more traumatological cases). Are the cost-savings in balance with the outcome?

To evaluate the activity of the outpatient care physiotherapy services in Hungary, according to the International Classification of Diseases (ICD) code system. Data were derived from the countrywide database of Hungarian Health Insurance Administration (HHIA), based on official reports of outpatient care institutes in 2008. The total number and the distribution of physiotherapy services were evaluated according to all of 21 ICD code groups for the year 2008. The different types of treatment codes are listed in the chapter of the Guidelines of HHIA for ‘Physiotherapists, massage-therapists, conductors and other physiotherapy practices’. The total number of physiotherapy services provided in 2008 was 28943680 interventions, of which the 20 most frequent treatments accounts for 72.03 % (20848928) of total services. The three ICD groups with the highest number of cases were found as the followings: 1) Diseases of the musculoskeletal system and connective tissue (60.74%); 2) Injury and poisoning (10.50%); and 3) External causes of morbidity and mortality (6.29%). The physiotherapy services occurred with the highest incidence in cases of the ‘diseases of the musculoskeletal system and connective tissue‘ ICD group. Therefore, authors suggest structuring the health care system and distributing resources to follow the needs supported by our findings.

In Hungary there are 10 institutes doing in vitro fertilization (IVF). The aim of the study was perform a data analyzis of the efficiency in an eleven-year period of Hungary involving all of the institutes' data. The database of the Hungarian National Health Insurance Fund Administration (NHIFA), the only health care financing agency in Hungary, was taken for the study. The analysis covers an 11 years period between 2000 to 2010. IVF success rate was defined as the proportion of number of live births and the number of IVF treatments. A total of 71,634 IVF treatments were done between 2000 and 2011 in the 10 institutes. 50 % of the IVF treatments were done from the age of 30 to 36. The total number of live births was 25,468. The number of single deliveries was 21,400 (84 %), twins 3779 (14.8 %), triplet 284 (1.1 %) and quadruplet 5 (0.02 %). The overall 11 year IVF success rate was 35.6 %. The success rate showed significant differences among IVF centers in a range of 31-49 %. The two largest IVF centres had a market share of 60.9 % and their success rate was 38.4 % and 34.3 % respectively. The highest efficiency was at the age of 34 (43.1 % birth rate). The mean of the IVF efficiency was 35.6 % in Hungary in the last 11 years. The best result was in the group of the patient at the age of 30-36. The efficiency could be increased if the selection of the patients were defined more precisely.

The aim of the study is to show the change in important parameters of intensive care units in Hungary from the year 2000 to 2010. Data of the analysis was taken from the financial database of the Hungarian National Health Insurance Fund Administration, the only health care agency in Hungary. We analyzed the number of hospital beds at intensive care units, the number of intensive care units, their average bed numbers, market share. The Hungarian health care system has had 150-167 intensive care units all over the country. The teaching and some county hospitals had more then one ICU. That meant 1183-1430 beds during the 10 years. We found the highest number of intensive care beds in 2006 (1430) which was significantly decreased in 2007-2008 below 1300 beds. The median range of beds at a typical ICU was between 5-9. The market share of intensive care hospital beds form the total number of acute care hospital beds increased from 1.8 % in 2000 to 2.9 % in 2011. The proportion of day provided with ventilation also significantly increased from 29 % in 2000 to 68 % in 2010. In Hungary the number of the ICUs and the number of the ICUs' bed did not change significantly in the last 10 years. During this period, the rate of the ventilation increased. The Hungarian intensive care units successfully managed to adapt to the changing hospital environment.