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

82
Health systems in transition Hungary
On the one hand professional associations do not have negotiation rights
on prices and outputs in the contractual process, on the other hand the NHIFA
is obliged to contract the providers that are selected or approved through
the capacity regulation processes of the government (see also section 2.8.2).
Similarly, family doctors, who are for the most part private entrepreneurs,
contract with the local government to provide services for the local population,
and the NHIFA is obliged to conclude a payment contract with all those
family doctors who have a local government contract. Physicians working
in outpatient and inpatient facilities are mostly salaried employees and not
contracted separately by the NHIFA, although they do have a contract for the
outpatient prescription of pharmaceuticals (for the role of the NHIFA regarding
pharmaceuticals see section 2.8.4).
Institutional health service providers have to contract with the NHIFA in
order to become eligible for reimbursement. The contract defines provider
capacities in terms of outpatient specialist consultation hours, and acute
and chronic hospital beds. Based on these contracts, individual health care
providers are then reimbursed from the sub-budgets by various methods of
payment: family physicians are paid by adjusted capitation, outpatient specialist
services by fee-for-service points, and acute and chronic inpatient services
by HDGs (Homogén Betegségcsoportok, HBCs) and patient-days respectively.
Until 2001, contracted capacities were determined per county and specialty by
law according to a special formula of local health needs (on the basis of certain
socioeconomic indicators of the local population), while the county consensus
committees agreed on the distribution of contracted capacities across individual
health care providers (1996/4). In 2001, Act LXIII of 1996 was repealed, and
the actual contracted capacities became the basis of future contracting (2001/5).
The law allowed greater flexibility for local governments to downsize and
restructure capacities. At the same time, capacity extensions had to be approved
by the then Ministers of Health and Finance. In 2006, the new government froze
provider capacities on 31 December 2006, then downsized and restructured
inpatient capacities (2006/12) (see more detail in 2.8.2).
As mentioned above, the NHIFA is not allowed to engage in selective
purchasing, and its contracting process is not based on systematic health needs
assessment. It has to contract with all providers who have a territorial supply
obligation. Until 2007 the quantity and quality of outputs were not stipulated
in the contract, except for a few high-cost, high-tech interventions, like liver
transplantation, for which the annual number of procedures was set in advance.
Since the beginning of 2004, the government has set output limits for inpatient
and outpatient care by defining the number of HDGs and fee-for-service