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

Health systems in transition Hungary 81
amount of contributions on behalf of the non-contributing groups by means of
the newly established National Risk Pool, leaving the hypothecated health care
tax, which has the same goal, intact. This measure, as in 1997, did not increase
the financial resources of the HIF, since this budget transfer was calculated
to eliminate the planned deficit of the HIF budget. Thus, only the timing and
legal form of the central budget contribution changed, but not its amount. The
strict cost-containment measures introduced in 2007 have yielded concrete
and measurable results in decreasing the overspending of the pharmaceutical
sub-budget of the HIF, although this was mainly achieved by increasing patient
cost-sharing (2006/9).
While most public revenues are pooled by the HIF, there is some pooling
fragmentation. The central and local governments are responsible for capital
costs of providers and different municipalities may allocate more or less to
health care facilities. This causes great variation in the physical infrastructure
quality of the health service delivery system. Richer municipalities usually
have better facilities, some poorer municipalities have accumulated debt in
order to maintain a proper infrastructure, while others have simply ignored this
obligation due to lack of funding. Any debts accumulated by local governments
add to the overall government budget deficit, forcing the central government to
formulate stricter regulations on the level of debt local governments are allowed
to accumulate. Although the central government provides grants to support the
development of infrastructure by municipalities, there is no explicit strategy
for reducing the inequalities created by this fragmented pooling and resource
allocation arrangement.
3.3.4 Purchasing and purchaser–provider relations
The organizational relationship between purchaser and providers is based on a
contract model since 1990, when the NHIFA was established and the ownership
of most public health care facilities was transferred to local governments
(1990/1). Although the NHIFA is a single payer with a monopsonistic market
power, it has very limited discretion over purchasing decisions, for example
to set the terms of the contract and to contract selectively with providers. The
National Assembly and the government regulate the most important elements
of the provider contract in acts and decrees, including reimbursement price,
capacities, quantity of outputs, payment methods and financing of capital costs.
As pointed out in published comparative literature, active contracting does not
actually take place in Hungary, but is often a formality for establishing the basis
for provider reimbursement (Figueras, Robinson & Jakubowski, 2005).