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

80
Health systems in transition Hungary
increasing revenue, decreasing expenditure or modifying the scope (breadth,
depth or height) of benefits (1992/1, 1997/8). Subsequent governments have
failed to address the chronic imbalance of the HIF budget in a systematic and
transparent manner.
Since the inception of the HIF, its expenditures have always exceeded its
revenues with the exception of some fiscal years (1995, 2007 and 2008). This
gap has been covered retrospectively at the end of each fiscal year through
deficit financing by the government budget. HIF revenues decreased from
7.8% of the GDP in 1993 to 5.5% of the GDP in 2005 (see also Table 3.6),
while expenditures only fell from 8.5% to 7.2%. The gap between revenues and
expenditures peaked in 2005 at 23.8% of total HIF expenditure (amounting to
HUF 375 billion or €1.48 billion or 1.7% of GDP). The peculiarity of the budget
management stewardship by the Ministry of National Economy is illustrated
by the fact that 91% of the gap between revenues and expenditures in 2005
was a planned deficit approved by parliament in 2004 (NHIFA, 2008), while
the rest was due almost exclusively to overspending in the pharmaceutical
sub-budget. As a result of effective cost-containment measures since 1997, such
overspending was not apparent in the inpatient and outpatient health services
sub-budgets.
Table 3.6
Revenues, expenditures and balance of the HIF, 1995–2011 (selected years)
Expenditure category 1995 1998 b 2001 2004 2007 2010 e 2011 e
Total HIF revenues (current prices, billion HUF) 422.9 561.5 884.7 1100.1 1676.0 1376.1 1370.9
– as % of GDP 7.3 5.4 5.8 5.3 6.6 5.0 –
Total HIF expenditure (current prices, billion HUF) a 445.1 632.2 915.0 1443.8 1648.6 1445.5 1462.3
– as % of GDP 7.7 6.0 6.0 6.9 6.5 5.3 –
HIF expenditures on health care (current prices,
billion HUF)
282.0 460.4 628.2 1014.2 1095.8 1161.5 118.8
– as % of GDP 4.9 4.4 4.1 4.9 4.3 4.3 –
HIF balance (current prices, billion HUF) a -22.23 -70.73 -30.28 -343.65 27.41 -69.41 -91.4
– as % of total HIF expenditure -5.0 -11.2 -3.3 -23.8 1.7 -4.8 -6.2
– as % of GDP -0.4 -0.7 -0.2 -1.7 0.1 -0.3 –
Sources: GDP: Ministry of Finance 2009/10, HCSO; HIF Revenues and Expenditures: NHIFA; Total and public expenditure on health:
OECD, 2009b.
Notes: a Includes cash payments, payments for in-kind benefits and administrational costs; b Change in the methodology of data
collection; e Estimated or projected.
The sudden improvement in the balance of the HIF budget in 2007 and
in 2008 was the result of the combined effect of a change in budget planning
and of measures to contain pharmaceutical expenditures. First, the parliament
decided to reintroduce the obligation of the central budget to pay a certain