How many diabetic patients are treated by the Hungarian Healthcare System and how? The role of GPs in an evidence-based care provision

Katalin Maria Dozsa, Petra Fadgyas-Freyler, Tamas Kovats, Peter Pollner, Tamas Joo, Tamas Toth, Orsolya Beres, Peter Kempler

Keywords: Type 2 diabetes, disease burden, primary care, prevention

Background:

Diabetes is an endemic affecting around 1 million Hungarians with poor outcomes of cardiovascular events and amenable death rates. Approximately 94 % of the patients have Type 2 diabetes, and their management belongs mainly to the general practitioners.

Research questions:

The study aimed to explore the total number of diabetic patients and to evaluate the provided services compared to guideline recommendations from the primary care perspective.

Method:

National Health Insurance Fund (NHIF) data were analysed based on the ICD10 code, International Classification of Procedures Codes in Medicine, and the ATC A10 code-related performance data of 2019.

Results:

The study revealed that the Hungarian healthcare system meets 1 million diabetic patients, while the number of patients redeeming prescribed antidiabetics with reimbursement in the pharmacies is far behind (618.459 patients in 2019.). The volume of the difference refers to the importance of stronger primary care. The structure of health expenditures shows that pharmaceutical and acute hospital care costs (37,8% and 28,6%) represent the most reimbursed services, whilst laboratory and outpatient spending made up a minor portion of total costs, 1,5% and 6,5% respectively. The medical treatment reimbursement took 79 % of diabetes-indicated health expenditures. The accessibility of preventive care services was poor: lower extremity Doppler examination affected 8,5% of patients, ABPM 1,6%, neuropathic diabetic feet examination 7,6%, and carotid artery duplex ultrasound examination affected 9,6% of patients. Most patients redeemed the cheapest medicines (metformin, sulphonylureas) and the lifesaving but expensive insulin-containing medications. The 40,1 % of patients redeemed novel antidiabetics.

Conclusions:

The overall healthcare spending can be called defensive: the critical, life-saving costs are dominant, while preventive care costs remain low. These characteristics do not have a favourable impact on healthcare-related amenable death. The accomplished study made it possible to identify reasonable interventions supporting prevention on the levels of primary care and outpatient care

Points for discussion:

1. The importance of national registries, continuous monitoring and feed-back to system development and financing

2. The role of competent GPs, APNs, GP clusters

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