Inequalities in hospice care at home in Hungary - results of the first district-level exploratory analysis of administrative data

Abstract

INTRODUCTION: Lack of information on hospice care at home in Hungary is evident. In the absence of performance measurement in our social policy, such as health and social care systems, means that the extent to which hospice patients and their families needs are met in Hungary remains unexplored. The aim of our research is to exploit and reach the full analytical potential of administrative data on hospice care at home to gain a more accurate picture of how the care system is performing today and how it contributes to the ultimate goal of improving the quality of life of progressive chronic patients and their families.

METHODOLOGY: Our analysis is based on the financial data of the National Health Insurance Fund, aggregated at district level in 2018. Our output variables are the number of patients reported in hospice care at home by district, looking at nominal and per 10,000 inhabitants, and the proportion of those who lived a long time after discharge. We considered a patient to live long time if a care event was reported in the calendar year 2018 for a patient who was still alive in June 2019, notably more 6-18 months after the reference period. These cases are considered in our study as misuse of the service.

RESULTS: In 2018, a population of 8 million lived in districts where admission ratio to hospice care at home was less than 10 patients per 10,000 inhabitants. Number of patients per 10.000 inhabitants is less than 5 in 86 districts. 37.0% of the population, 3,652,756 people live in these districts, where less than 4% of those who died was admitted to hospice care at home. From 183 districts with at least 1 hospice care at home care event, 18 had a rate above 50% with patients still alive long after the reference period, which we considered as misuse. Our results show that there was no hospice care at home event in all districts of the country, there were significant inequalities in access to care by place of residence, and the exploratory analysis already reveals dysfunctionality and misuse of care.

CONCLUSIONS: The initial results of the exploratory analysis cannot, of course, give an accurate picture of the quality and access to care, but they can demonstrate and illustrate why either national or county-level data analysis can effectively conceal major inequalities. Our paper argues for the approach presented here to be taken to enable governance and policy makers to plan interventions effectively and measure their impact routinely.