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

Health systems in transition Hungary 73
health services are covered and exclusions must be stipulated (1997/9). Also in
1997, new legislation on health and health insurance was enacted to address the
issues of rationing and priority setting in a more systematic manner. Act CLIV
of 1997 on Health introduced the concept of waiting lists and stipulated that
waiting list priority must be assigned based on uniform and explicit criteria,
taking into account patient health status (1997/20). Act LXXXIII of 1997 has
made it possible to deviate from the waiting list order only in cases where
both the reason for and the importance of the outcome of the intervention have
been attested to officially (1997/9). Thus far, central waiting lists have been
set up for organ and tissue transplantation and positron emission tomography/
computer tomography (PET/CT) services, which are managed by the National
Blood Supply Service (NBSS; Országos Vérellátó Szolgálat). Waiting lists for
all other services are to be set up by the providers contracted by the NHIFA
in the event of persistent shortages in the capacity to provide the necessary
care (1997/9, 2006/9). Outpatient institutions must keep ordered lists of
patient access (appointment lists), based on the priority of service provision
dates that is established. Between 2007 and the first half of 2010, the waiting
and appointment lists were supervised by the Health Insurance Supervisory
Authority (HISA) (2006/10, 2006/14) and in certain cases by the NPHMOS.
Then, upon abolition of the HISA, this task was partly transferred to the NHIFA
(2010/9, 2010/10, 2010/11).
Depth of coverage
Co-insurance and co-payments are required for pharmaceuticals, medical
aids and prostheses, balneotherapy, dental prostheses, treatment in sanatoria,
long-term chronic care and some hotel services in hospitals. Co-payments are
also due if:
• non-emergency specialist services are obtained without a referral from an
authorized physician, normally the family doctor;
• patients choose to visit a provider other than the one they were referred to
(see also section 2.9.2);
• patients desire more services than those prescribed by their physician
(1997/9, 1997/18).
Special rules apply to a few services, such as infertility treatments, for
which the number of attempts covered by HIF is limited (1997/16). The costs
of medical examinations required to certify an individual’s fitness to drive or
hold firearms are not covered (1997/18). Treatments for aesthetic or recreational
purposes are explicitly excluded, as are those which have not proved effective