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

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Health systems in transition Hungary
In 2009, the State Audit Office published a study on the contracting out of
hospital services and on concession contracts for operational rights. The report
concludes that in most cases the outsourcing process has been determined by
private companies rather than by public authorities (State Audit Office, 2009b).
3.4 OOP payments
OOP payments in the Hungarian health care system can be divided into three
main categories. First, patients pay user charges for services and products
that are only partially covered by HIF (cost-sharing). Second, some products
and services are not covered by HIF and are financed out-of-pocket (direct
payments) and, third, some patients pay physicians and non-medical health
professionals informally for services, even if these are covered by HIF (informal
payments). This phenomenon, also known as under-the-table, envelope or
gratitude payment, is a legacy of the state-socialist health services and has
continued to play a role in the Hungarian health care system despite 20 years
of continued health care reforms.
According to the OECD (2010), the share of OOP payments in total health
expenditure increased from 16.0% in 1995 to 23.7% in 2009 (Table 3.1). In total,
56% of OOP spending in 2007 was on pharmaceuticals and medical aids, and
42.8% was on medical services. The overall magnitude of OOP expenditures
has also been controversial: according to the National Health Accounts, the
household budget surveys underestimate not only informal payments, but also
total OOP payments (Table 3.7). The structure of OOP payments is similar if
data reported by households are used: in 2007, 56% was spent on outpatient
medical goods and 44% on health services, including informal payments. In
any case, the various data sources agree that OOP spending increased more
than twofold in real terms, and by 80% as share of GDP between 1993 and 2007,
and within that informal payments at least stagnated both in real terms and as
a share of total OOP expenditures.