Health Systems in Transition - Hungary - World Health Organization ...

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Health systems in transition Hungary
NHIFA or (b) obtained this treatment in accordance with bilateral international
treaties or the European Commission Regulation 883/2004, which deals with
the provision of health care in EU Member States.
Before 2004, there was no systematic, formal or transparent process for
deciding which services would be included in or excluded from the benefits
package. With EU accession in May 2004, Hungary was obligated to adopt
Council Directive 89/105/EEC. This regulation aimed to ensure that transparent
measures are adopted by national authorities in the pricing and reimbursement
of pharmaceuticals. Adopting this regulation, the government established the
process of HTA to evaluate applications by pharmaceutical companies (2006/8).
The NHIFA uses various criteria in the decision-making process, such as health
needs, cost-effectiveness and budget impact (2004/4) in order to classify certain
pharmaceuticals for different categories of reimbursement (see sections 2.7.2
and 2.8.4).
The first steps towards a less generous benefits package were taken during
the economic crisis of 1995, when the HIF deficit led to calls for urgent action
(see section 3.3.3). Act XLVIII of 1995 on the Amendments of Various Acts
for the Purpose of Economic Stabilization subsequently curtailed both in-kind
and cash benefits. The main item excluded from the benefits package was
tooth-preserving dental services for adults. Subsidies for balneotherapy were
also removed, a co-payment for patient transfer (i.e. ambulance) services
was introduced, and sickness benefits were reduced (1995/5). In addition,
employers became responsible for financing occupational health services
(1995/8). The adverse effects of these measures – for example, a sharp drop
in the use of dental services – forced the government in power from 1994
to 1998 to reconsider the exclusion policy and reintroduce dental services
with some co-payments (1996/1) for adults. The next government abolished
co-payments for tooth-preserving dental treatments in 2001, thus restoring the
original situation (2001/10). Nevertheless, the share of OOP spending on dental
services has remained very high, with total OOP expenditure in this category
amounting to HUF 106 billion (€418.7 million) in 2007 and thus exceeding total
NHIFA expenditure on dental services by a factor of five (OECD, 2010). OOP
expenditure in this category represents 19.3% of the total private expenditure
on health in Hungary.
Act LXXXIII of 1997 on the Services of Compulsory Health Insurance
and related decrees define which health services are free of charge, which
are covered but require some user charges, and which are excluded from HIF
coverage. The Act defines a negative list based on the premise that, in principle,