Policy responses for Hungary - HSRM


Policy responses for Hungary

5. Governance

5.1 Governance

The GOVERNANCE of the health system with regard to COVID-19 relates to pandemic response plans and the steering of the health system to ensure its continued functioning. It includes emergency response mechanisms, as well as how information is being communicated, and the regulation of health service provision to patients affected by the virus.

Hungary had a national pandemic response plan in place before the outbreak, but it was specific to pandemic influenza. It was created in 2009, when the H1N1 appeared. The content was the following: impact of the pandemic on society, on health system and on economy; organizations and the legal framework of their work in the preparedness for the pandemic and in the eradication of pandemic; phases of pandemic [1].

On the 11th of March, the Government declared a State of Emergency. As part of this, hospital commanders were appointed to the 108 inpatient care institutions on 29th March. The duty of hospital commanders is to ensure the availability of the stocks and protective equipment necessary for the maintenance of smooth medical activities and to guarantee the security of supplies and equipment. Furthermore, they can relieve hospital staff of various statistical data services. Hospital commanders are not allowed to state opinions, make recommendations or adopt decisions on medical issues. Hospital directors are obliged to comply with the instructions of hospital commanders in two areas: issues regarding the security of assets and compliance with disease control regulations [2,3].

As part of the State of Emergency regulation package, the Criminal Code of Hungary changed, which amended the existing crime of scaremongering with obstructing epidemic prevention. From the 31st of March, “any conduct of uttering or publishing a statement one knows to be false or with a reckless disregard for its truth or falsity at times of special legal order with intent to obstruct or prevent the effectiveness of protective measures shall be construed a felony offense and shall be punishable by imprisonment between one to five years.” [13]

From the 29th of April the competence of hospital commanders extends not only to hospitals but also to nursing homes with at least 200 beds. This allows hospital commanders to supervise stock management in nursing home facilities, but they cannot make decisions on nursing, care and medical issues. [4]

The national response to COVID-19 is led by the government and is supported by the so-called Operative Corps, jointly led by the Interior Minister and the Minister of Human Capacities, with representatives of relevant organizations, such as the national chief medical officer of the National Public Health Center. The measures of the government are mostly announced in regular, daily press conferences of the Operative Corps except those with strategic importance communicated directly by the Prime Minister (for more details about communication please see Section 1.1 – Health Communication). The national chief medical officer of the National Public Health Center is responsible for the implementation of the epidemiological interventions together with the county and district offices of the Government Office, in particular their public health departments and units (formerly they were the regional offices of the then unified National Public Health and Medical Officer Service). They are coordinating the surveillance and the testing.

The government is constantly monitoring the plans of other European countries regarding exit strategies. In Hungary, the restrictive measures will be in place until the 3rd of May. The details of upcoming relaxation measures will be discussed and announced during the last week of April.

At the recommendation of the Chief Medical Officer, in response to the Minister’s proposal, the government may declare a state of health care crisis which amounts to a state of disease control preparedness. During this period, patients are cared for according to the protocol of a state of health care crisis. A state of health care crisis can last for a maximum of six months and is revised every three months, unless the government extends the measures [10].

An epidemiological deployment unit within the Operative Corps, headed by the Deputy Chief Medical Officer, has been established [11]. If immediate intervention is needed in a particular area due to a high number of coronavirus cases, the deployment unit should go on site.

On the 18th of November, Hungary established the National Hospital Directorate General. Its tasks are to monitor the functioning of the health care system, to substantiate the strategic government decisions about the review of health care system and to contribute to the development of a coherent and transparent new national health management system. During the State of Emergency, the Minister of Interior is controlling the new institution. The National Healthcare Service Center that is currently practicing state ownership rights at the state/publicly owned Hungarian hospitals will merge into the newly established National Hospital Directorate General and thus ceases to exist after the 31st of December [12].

[1] https://www.antsz.hu/data/cms26491/Pandemias_Terv_20090818.pdf?archived=true
[2] https://www.kormany.hu/en/ministry-of-interior/news/duty-of-hospital-commanders-is-to-facilitate-containment-effort
[3] https://koronavirus.gov.hu/cikkek/megkapjak-megbizoleveleiket-korhazparancsnokok
[4] https://koronavirus.gov.hu/cikkek/200-fo-feletti-idosotthonokra-kiterjed-korhazparancsnokok-hataskore
[5] https://koronavirus.gov.hu/cikkek/tobb-ovintezkedes-mellett-tartjak-az-idei-erettsegi-vizsgakat-0
[6] https://www.kormany.hu/en/ministry-of-human-resources/news/more-than-84-000-students-could-take-final-examinations-on-monday
[7] https://koronavirus.gov.hu/cikkek/kormanyszovivo-augusztus-15-ig-semmilyen-tomegrendezvenyt-nem-engedelyeznek-az-orszagban
[8] https://koronavirus.gov.hu/cikkek/budapesten-es-pest-megyeben-marad-kijarasi-korlatozas
[9] https://nepszava.hu/3076539_sok-uj-szaballyal-indul-hetfotol-a-betegellatas 
[10] https://www.kormany.hu/en/prime-minister-s-office/news/parliament-adopted-law-about-termination-of-state-of-danger
[11] https://koronavirus.gov.hu/cikkek/lakatos-tibor-jarvanyugyi-keszenlet-pillere-lesz-jarvanyugyi-bevetesi-egyseg
[12] https://koronavirus.gov.hu/cikkek/kormanyrendelet-veszelyhelyzet-idejen-pinter-sandor-iranyitja-az-orszagos-korhazi
[13] Act of C 2012