The context for supply and demand of public online services in Hungary

Hungary is a centralised state with four levels of government. The Central State Level (CSL) consists of the national parliament, central government, government departments and a range of central offices. Hungary is divided into seven regions (Regional Level or RL), 19 counties (megyek), 22 urban counties (megyei varos) and the capital city, Budepest (fovaros). Finally, the local level (LL) consists of over 3,200 local governments.

Hungary has a population of just over 10 million (as of July, 2005). It has made the transition from a centrally planned to a market economy, with a per capita income of 50% of the Big Four European states. Hungary continues to demonstrate strong economic growth. The private sector accounts for over 80% of GDP. Foreign ownership of investment in Hungarian firms is widespread. Hungarian sovereign debt was upgraded in 2000 and together with the Czech Republic holds the highest rating among the Central European transition economies. However, concerns have been expressed over Hungary's unsustainable budget and current account deficits. Inflation has declined from 14% in 1998 to 7% in 2004. Unemployment has stayed around 6%, but Hungary's labour force participation rate of 57% is one of the lowest in the OECD.

Key figures about Hungary[1]

	Hungary	Ø EU15	Ø EU25
Old age dependency ratio	22.6	25.5	24.5
Population density	109.5	119.8	116.3
GDP per head	62.7	108.6	100
GDP growth - 5 year average	3.88%	1.85%	1.92%
Unemployment rate	5.9%	8.1%	9.0%
Inequality index	25	30	29

Hungarian ICT policy developed about 15 years ago. An expert group set up by the Government developed the Information Infrastructure Development Programme, which lasted from 1986 to 1994. A series of other strategies were implemented after this: The National Information Infrastructure Development Programme (1995), The National Informatics Strategy (1996), the Governmental Informatics Strategy (1997), and the 'Széchenyi Plan' (2000). The National Development Plan 2001-2006 (2003) contains a chapter on ICT preparedness and strategy.

According to the SIBIS research[2] the Hungarian public began to use the Internet earlier than most other Central European countries, but by now the proportion of Hungarian Internet usage is under the Central European average.

Information Society indicators[3]

	Hungary	Ø EU15	Ø EU25
Households with Internet access	14%	45%	42%
Broadband penetration	2.2%	7.6%	6.5%
Price for Internet use basket	93.34	49.57	48.35
ICT expenditure as percentage of GDP	7.2%	3.2%	2.6%
Digital Divide Index	37.3	53.0	50.1

17% of the Hungarian population access the Internet regularly and 5% access it occasionally, as compared to the Central European average of 21% and 5% respectively[4].

Hungary's performance on the UN Telecom Index[5]

On the Digital Divide Index, a compound indicator measuring disparities in the uptake of home computers and the Internet along four dimensions (gender, age, educational attainment, income), Hungary is sixth from the bottom of the table, scoring below both the EU 15 and EU 25 averages. This suggests that participation in the Information Society is strongly unequal in the country.

eHealth in Hungary

Overall, eHealth in Hungary is in its early stages of development, and is restricted to the provision of information on traditional contacts (such as names, addresses, telephone numbers and opening hours). Online health services such as consultation and administrative transactions are not yet in place.

The main barrier to the implementation and uptake of eHealth services in Hungary is the under-funding of the health system in general. This is aggravated by an absence of clear responsibility for different roles within the health system, and the fact that the health system has not undergone reform since the time of state socialism.

Key figures about the Hungarian Health System [5]

	Hungary	Ø EU15	Ø EU25
Percentage satisfied with own health	60.5%	82.5%	79.8%
Prevalence of long-term illness	32.0%	13.8%	20.0%
Doctors per 100,000 inhabitants	318.9	233.0	250.6
Health expenditure as percentage of GDP	5.3	7.4	7.3

However, this may change as a result of the implementation of the Hungarian eHealth Strategy[6].

In 2004, the Ministry of Health set up an eHealth Programme Management Unit under the umbrella of its National Institute for Strategic Health Research. The key aims of the National Health IT framework are to serve:

• the population

• the health system directly

• evidence-based health policy making

Five key steps were involved

1. building an information policy
2. setting up and using proper health and service delivery indicator sets
3. building reliable health information content
4. inducing health IT standard building
5. running and co-ordinating a set of health IT system development projects

Under the eHealth Strategy, 22 eHealth programmes were identified, of which the following were classified as top priority initiatives:

• Implement a comprehensive health and social monitoring system

• Establishment of a telephone and online health information and advice service

• Regional demonstration pilots of integrated health information systems

• Modernisation of health and social information systems

• Implement foundations of eBusiness for health services

Under the eHealth programme, a number of projects are being implemented. Those most relevant to this brief are listed below:

Supporting the Medical Community by eHealth -The Medical Professional Boards in Hungary act as the highest professional bodies making proposals, expressing opinions and giving advice to the Minister. One of their tasks is the preparation of clinical guidelines. Currently, the latest software development in health care provides geographically dispersed professional boards with a suitable infrastructure for writing clinical guidelines. The software is available via a website provided as a service of the National Health Portal (see below). The website provides services such as shared documents, automatic version trading, task scheduling, computer security and publication.

A National Health Portal is planned for launch in 2005 (this has not yet been achieved). The project aim is to develop a central gateway to health and health-care related information supporting the information needs of health professionals. A number of its services is already operational (see above). The portal will allow health professionals and businesses to interact seamlessly with each other. It will also provide access to a set of medical databases and certified registries. It already provides access to evidence-based medicine (CE-online), drug information and medical eBooks in Hungarian. In the long term it is envisaged that the portal will host medical communities and will provide a means of electronic transaction services such as ePrescription - these and other services are expected to emerge as a result of the introduction of digital signatures.

Dr Info - Hungarian Health Care Information Service for Citizens is an Internet and call centre-based service providing health care information for citizens. In its present state the service provides information on

• availability of health care services (in and out-patient services and pharmacies, addresses, opening hours, doctors on duty)

• general information on the structure, availability and function of different health care providers

• phone numbers for different support organisations

• popular medical eBooks about illnesses and home care.

The telephone service is available 16 hours per day Monday-Friday and 10 hours a day at weekends. Calls are charged at local rates and all calls are recorded. To progress Dr Info a number of actions are envisaged for the future:

• rethinking and reorganising the functionality and content of the website as a result of moving it to the Hungarian Health Portal (see above)

• content to be overseen and defined by an editorial committee

• the call centre is to be restructured, it will operate based on its own operational and organisational policy and quality assurance system

Other steps include the adaptation of a self-help guide book which will help to identify symptoms by answering simple step-by-step questions and work out the best course of action. As an extension to this book the call centre will be able to manage symptoms and complaints calls, when the operator could advise the caller of the need and urgency of medical attention based on medical expertise software.

Disability Portal is a project aiming to create and run a comprehensive Internet portal which collects specialised information and useful services for all the people involved in the disability issue as an information database. This project is discussed in more detail below.

One of the measures of an ERDF-financed Operative Programme is "IT Development in Health Care in Regions Lagging Behind". The Measure focuses on the development of a pilot inter-institutional ICT system among health care providers in three underdeveloped regions of Hungary: Northern Hungary, Northern Great Plains and Southern Transdanubia. The development will connect all levels of health care, e.g. hospitals, clinics and general practitioners. The system will provide 'eHealth' services (such as eHealth Records, eConsultation and ePrescription) for all participants using modern, Internet-based, secure communication channels. As a result, patient pathways will be shortened, and the health care of the region will be more cost-effective. A secondary goal of the measure is the development and integration of intramural institutional information system components. As a result of the developments, advanced information system components (hardware, LAN, software applications) will be implemented within the institution to support more cost-effective operation. The three beneficiary consortia were selected by evaluating their applications. The inter-institutional ICT system development, common in the three regions, will be co-ordinated by the Ministry of Health. As a first step the detailed functional system plan of the inter-institutional ICT was elaborated by the experts of the three consortia and experts provided by the Ministry of Health. The tender for the development was announced in March, 2005.

Last but not least, the Minister of Health is currently preparing to establish a pilot Trusted Third Party (TTP) service for the health sector through the "Preparatory Project for the Application of Digital Signature at Inter-institutional Health Data Exchange".

User orientation in eHealth services

There are a number of eHealth portals available in Hungary. Most of these are run by private companies, with the exception of Dr Info - an official site was set up by the Ministry of Health Care, Social Care and Family Affairs and www.psychologia.hu, a site set up by the Hungarian Psychology Association.

All of these portals provide information on a wide range of health-related issues such as medical conditions, health promotion (such as nutrition, healthy living and so son), patient support groups, alternative therapies and mainstream service providers. Two (Dr Info and Patika Magazin also provide information and assistance via the telephone, and two offer an online communication facility with site doctors.

Another source of online health information is provided by major Internet content providers like www.origo.hu , www.index.hu and www.startlap.hu, all of whom provide their own health-related page, often with grouped links and search engines. Of particular interest is www.orvos.lap.hu, set up by startlap.hu. This site lists a large number of links grouped according to different health service providers (general practitioners, specialists, private doctors, psychologists, dentists, pharmacies, private hospitals and clinics). This is probably the biggest collection of health-related links in Hungary.

Regarding the extent to which family doctors or public health clinics provider user-oriented websites, while there are links to GPs, private doctors and hospitals, the online facilities are considered to be rather simple and unsophisticated. For this reason, health contacts tend to be made via telephone. The planned introduction of digital signatures in the Hungarian health system could change this situation.

Internet Use for Searching Health Information[7]

Online pharmacies in the true sense of the term (i.e. those that allow the purchase of prescription drugs online) do not exist in Hungary as the law requires a prescription to be presented, in person, to the pharmacists by the patient. Again, the introduction of digital signatures may change this situation.

One important step towards developing a user-oriented approach to eHealth is the Disability Portal planned for 2005. The Disability Portal has 10 aims:

• to provide an information service for:

• disabled people,

• non-disabled people,

• friends and family of disabled people;

• to provide a database service;

• to present life stories of disabled people;

• to provide a counselling service;

• to support the formation of relationships;

• among disabled people;

• to make contacts with those involved with;

• the disability issue;

• to build community relationships;

• to support labour services;

• to provide other services;

• web marketing.

The Disability Portal contains seven main segments. The general area is the place of information and publications that are connected to disability. Specific portal areas deal with issues such as sensory disability, intellectual disability and pervasive developmental disorders such as autism. It is envisaged that the portal will be launched in the course of 2005.

Satisfaction with National Healthcare System[8]

eUser - the Project

The eUser study is funded by the European Commission's IST (Information Society Technology) programme. eUser is a major research and support project which has set out to provide solid evidence as to users' real needs regarding eGovernment, eHealth and eLearning offers, as well as providing data about their attitudes and the uptake levels of current public online services. The project supports the IST programme to achieve its key objectives of putting the user and his/her needs at the centre of IST developments. It provides empirical information on key public eServices domains -eGovernment, eHealth, eLearning - identified as priorities by the European Council, and assesses the demand/supply match in these fields.

The eUser Approach

To achieve its objectives, eUser addresses both generic user-related issues and domain-specific topics, and develops a globally accessible repository of evidence-based knowledge, methods and best practice examples. It pursues an extensive programme of active knowledge translation, transfer and dissemination supported by sophisticated online knowledge dissemination tools. The knowledge base will consolidate both existing knowledge and approaches, and novel data generated by the project through representative population surveys (demand side) in old and new Member States, and through comparative analyses of readiness to address user aspects of public eServices in each Member State (supply side).

The project is designed in two phases. Phase I - the preparatory phase - has developed a conceptual framework that systematically identifies and cross-references user issues and service characteristics in relation to online public services. An EU-wide population survey regarding the needs, experiences and requirements of both current and potential users of online public services has been carried out in early 2005. Concerning the supply side, information from national public sector environments has been collected, about the degree to which the European public sector pays sufficient attention to user-orientation of online services. Good practice examples regarding user-appropriate online public service provisions are being identified and described.

All these results build the basis and provide content for the eUser interactive online knowledge base and support service which is being set up as an online observatory on user issues. This constitutes the basis for active support services on user-centred topics which are being made available inside and outside the IST programme.

eUser Country Briefs

This document has been prepared by the Work Research Centre based on information provided by a National Correspondent (Prof. Dr. György Lengyel, The Institute of Sociology HAS) as well as secondary data sources such as Eurostat and other Commission Services.

25 eUser eHealth Country Briefs are available in a common format, one for each member of the enlarged European Union. You can access and download these documents in PDF format (for free) from our website.

Notes About the Data Sources Used in This Document