palliative care worldwide from villages to metropolis katalin muszbek md. hungarian hospice...
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Palliative Care Worldwidefrom villages to metropolis
Katalin Muszbek MD.
Hungarian Hospice Foundation
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Palliatvive care development in Eastern – European Region
Poland – first steps at the 70es
Jaczek Luczak – key person Regional PC education in Poland with
international faculty British model From 90es - activities of the hospice groups in
the region
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Palliative Care in Hungary
Since 1991 – start of the Hungarian hospice movement: first palliative care group:
Hungarian Hospice Foundation
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Strenghts of Palliative Care in Hungary
Well orgaized care based on minimum standards
Legal backround, strong policy High public awareness International training resource centre
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Strengths - clinical activities
Well organized PC services Activities only on minimum standards PC guideline
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Strengths - legal background
Hospice paragraph in the health law – 1997 Regulation on PC – 2004 Palliative Care Development Project –
collaboration with National Health Insurance Fund – 2004 PC is a part of National Cancer Control
Program
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Strengths - public relations
High public awareness Publicity campaignes since 2000 High media representation
in 2007 more than 100 publications, interviews in electronic and written media
Programs for children
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Strengths - education
Budapest is an International Training Resource Centre
Open Society Institute Conferences for Eastern Central European PC professionals – 2003, 2004, 2005 - 12 countries
40 hours PC courses for Eastern European region and former Sowjet Union countries
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Weeknesses of PC in Eastern-Europe
PC sevices are not awailable all over the country
Lack of PC training of physicians Low – scarce financial resources
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Weeknesses – PC services
PC services are not awailable all over the country
White spots of care 225 PC beds – WHO recommends 500 for 10
million population
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Weeknesses - education
Medical curriculum without PC issues6000 hours of whole curriculum – less than 200 on symptom controll, on death and dying,on breaking bad news
No PC specialisation for physicians Low motivation of physicians for PC
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Weeknesses - finance
Low financial resources NHIF covers 50% of the budgets of PC services Donation is not traditional Few grants on PC topic
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Where is Hungary now?
Increased number of PC services (2x)
Legal development: (2004)
- minimum standards of palliative care
- Ministry of Health decree on finance
Finance: financial demonstration project for palliative care (NHIF) (2004)
Second part of this year new opportunities for extending PC - NHIF support
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Where is Hungary now?
National development plan 2007-2013: integraton of Palliative Care into the National Health System (new reform) (2006)
Palliative care and psychosocial care became an integrated part of National Cancer Control Program (2006)
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However…
PC is not awailable all over the country Scarce of training and interest of physicians to
PC Low state fund and lack of donation are barriers
for further development
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Conclusion
Further lobby is needed for increase number of PC services and to involve more physicians
New approach – to influence attitude of children toward end of life and solidarity:
FIELDS OF HOPE project since 2007
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