HSRM Countries

10 November 2020 | Country Update
Maintaining essential services

3.3. Maintaining essential services

Initial response

Non-emergency procedures and examinations are postponed in most of the hospitals. The Professional College of Health (an advisory body of the Minister for Human Capacities) published a recommendation to postpone procedures for non-life-threatening illness. According to the recommendation, surgeries should be avoided whenever possible. Emergency cases and interventions that are necessary to avoid the deterioration of the health status of patients are exceptions (for example, removal of surgical stitches, tending of wounds, prenatal care, oncological care) [1, 2]. Dentists are allowed to perform only emergency care. Certain restrictions on the prescription of pharmaceuticals have been removed, ePrescriptions are available and can be redeemed by anyone on behalf of the patient since 13 March 2020. After the State of Emergency was lifted, ePrescriptions remain in place without an expiration date.

Municipalities are organizing the work of volunteers to help the elderly people. They purchase and deliver essential foods and medicines to vulnerable people, specially to elderly living alone. Moreover, they provide information for them and in some cities, food collection is organized as well [3].

The National Public Health Center has a procedure on COVID-19 infection preparedness and infection control tasks in the residential social institutions that supplements the ministerial orders. The procedure highlights, for example, that workers should have infection control education including hand hygiene and usage of protective tools, there should be enough hand sanitizers and soaps, the institutions should introduce daily monitoring of all residents by tracking their symptoms and measuring their body temperature twice a day, and staff involved in the handling of suspected or confirmed COVID-19 cases should be identified.

After the COVID-19 outbreak in some elder care homes, on 15 April 2020 the Chief Medical Officer announced a nationwide inspection of elder care homes. The inspections will determine whether the institutions carried out the measures required by the authorities, whether medical care was available, whether the relevant training has been provided for personnel, whether the necessary human resources and physical conditions are available, and whether the relevant protocol is being observed. The availability of individual protective supplies and the entire care process is under assessment as well.

Transition measures

From 4 May 2020, the government will lift restrictions on private healthcare and on some parts of publicly financed healthcare. Primary healthcare, dentists, outpatient care (including diagnostic care), one-day care and from inpatient care rehabilitation and transplantation can operate again with the following rules (but telephone consultation remains the primary way of treatment [4, 5, 6]):

The patients should ask for an appointment on the phone.
The patients undergo body temperature measurement and risk assessment.
There is mandatory PCR testing before some treatments. Hospitals and outpatient care providers take the sample themselves for the coronavirus exclusion certificate (PCR test). For dental treatments, the test is only required for patients with suspected infection. For individuals seeking dental treatments, the test will be ordered by the GP, and the sample will be taken by the emergency ambulance staff at their home.
Patients should wear a face mask and use hand sanitizer before entering an outpatient care facility.
Up to four patients can be examined in one hour.
A distance of one and a half metres between patients must be maintained in the health care facilities.
Regular disinfectant cleaning of the heathcare facilities is required.
The healthcare workers should get protective equipment and hand disinfection opportunity.

On 14 May 2020, the minister heading the Prime Minister’s office announced that the number of coronavirus patients is decreasing significantly. The minister indicated that if this process continues, healthcare will be allowed to return to normal conditions, and the beds that were freed up for COVID-19 cases could be used for normal therapy again.

On 25 May 2020, the Chief Medical Officer announced that the organized public health screening programmes will start again on 1 June 2020. These include mammography examinations for the 40–65 age group, cervical screening for younger age groups, and colon cancer screening for the 50–70 age group [7].

From 15 June 2020, all healthcare services are available without restriction. In hospitals, 80% of the beds reserved earlier for the care of coronavirus patients can be restored to other therapies; however, 20% of beds must be reserved for treating coronavirus patients. The rule of four people per hour introduced for general practitioners and specialist physicians has been abolished; however, healthcare services can still only be used by prior appointment made by telephone.

In a ministerial order, Miklós Kásler, the Minister of Human Capacities, ordered the suspension of elective surgeries, including one-day surgery, from 9 November 2020, and designated (almost) all hospitals to treat patients with COVID-19. Exceptions from the suspension are emergency care, oncology care, organized oncology screening, cardiology care as recommended by the professional college, and assisted reproductive procedures. Transplantation can also be performed with strict adherence to epidemiological precautions.

From 7 November 2020, the healthcare institutions are required to reserve 40% of their beds and a further 7% as a ventilated bed for the care of COVID-19-infected patients.

Inpatient facilities should properly isolate the patient and perform a rapid antigen test if infection is suspected. In case of a positive test result, the patient can be placed in a common room with other the confirmed patients. In case of a negative result, PCR test is also required. Until the PCR test result is confirmed as negative, the patient should be isolated.

Reimposition of stricter measures

Inpatient facilities should properly isolate the patient and perform a rapid antigen test if infection is suspected. In case of a positive test result, the patient can be placed in a common room with other the confirmed patients. In case of a negative result, a PCR test is also required. Until the PCR test result is confirmed as negative, the patient should be isolated.

It was announced on 26 November 2020 that the prescriptions from specialized doctors that expire during the state of emergency will remain valid for 90 days after the end of the state of emergency. The lending time of medical aids and the prescriptions redemption deadline will be extended to 30 days after the end of the state of emergency.

On 3 February 2020, the Chief Medical Officer announced that the Minister of Human Capacities allows day surgeries except for dental surgeries and ear, nose and throat treatments. On the day of the surgery, the patient needs a negative PCR test not older than 72 hours [8].

On 26 February 2020, the Prime Minister announced enhanced preparedness in hospitals, which will suspend same-day surgeries [9].