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

Health systems in transition Hungary 83
points, which are paid for by the NHIFA, for each health care provider (see also
section 3.7). Above the set quantities health care providers receive no additional
payment. Quality control, on the other hand, is a task of the NPHMOS. The
NHIFA has the right to monitor contracts, mainly by controlling the validity of
providers’ reports on output.
Private providers contracted by the NHIFA are family physicians,
pharmacies, pharmaceutical wholesalers and traders, and providers of certain
diagnostic services and kidney dialysis, dental care services, patient delivery
transport services, district mother and child nurse and school health services,
as well as a few outpatient specialist care and inpatient care providers. This
latter group includes hospitals owned by churches or charities, which are fully
integrated into the publicly financed health insurance system. There is one
private profit-making hospital contracted only for the provision of same-day
surgical procedures.
The participation of private providers in health service delivery in Hungary
started with the dialysis services in the early 1990s, followed by diagnostic
services as of 1996. Private providers were initially involved in the outsourcing
of various types of medical services and then increasingly in ancillary services,
such as laundry, catering, accounting and performance reporting. However,
since the mid-2000s, the entire management of hospitals and outpatient
specialist providers (polyclinics) can be subject to outsourcing (functional
privatization, i.e. when only the management of the service provider has been
contracted out).
The management of hospitals owned by local governments has been
contracted out in many cases. Contracting out the provision of certain services
and management is a widespread phenomenon, which started in the mid-1990s
and has been evolving towards the corporatization of providers. Thus, a large
number of private providers, with varying scopes and levels of services, can
take part in the provision of health care services without a formal contract with
the NHIFA. In the case of functional privatization, the private management
company takes over NHIFA contracting from the local government, which
remains the owner of the facilities. In hospital care, the first concession contract
for operating a hospital was signed in 2004 and more followed. However, the
flagship actor in the private health industry (Hospinvest) declared bankruptcy in
2009 and returned management rights to the owners, that is, the respective local
governments, causing intensive public and media debate across the country. Its
failure was a serious blow to the functional privatization model.