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

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Health systems in transition Hungary
of pharmaceutical expenditures of the outpatient sector in 1992, one-third in
2000 and 40% in 2007, according to National Health Accounts data. There is
an exemption system in place for persons with very low income, who can get
the necessary medications without user charges. Eligibility is based on means
testing administered by local governments (1993/1) (see also section 5.6).
User charges for dental prosthetic treatments and above-standard hotel
services can be determined by the providers themselves, within the limits of
certain rules set by the Act LXXXIII of 1997. In contrast, the government
centrally sets the amount of co-payments for long-term and chronic care, as
well as for services that have been utilized bypassing the regular referral system
(see also section 2.9.2). These fees equally apply to all providers. For instance,
the co-payment for long-term chronic care has been around HUF 400 (€1.5) per
day since 1998 (1997/18), which was equivalent to one and half litres of milk
or one hour parking in the city centre of Budapest in 2010. Providers retain the
revenue from any of these sources, but HIF reimbursement on these cases is
reduced accordingly (1997/9).
In February 2007, health policy moved sharply towards introducing a flat
co-payment in outpatient and a per diem in inpatient care (2006/9) in order to
curb excess utilization. Exemption schemes were also implemented to protect
vulnerable social groups based on their socioeconomic status and to reduce the
public resistance in general towards these new types of user charges. Providers
thus obtained an additional HUF 13.3 billion (€52.5 million), amounting to
about 0.7% of total health expenditure (NHIFA, 2008). These measures
became a point of substantial debate and were capitalized upon politically by
the opposition parties. The referendum held on 9 March 2008 on user charges
had a high turnout and overwhelmingly rejected the policy (2008/2). Thus, the
new user charges were withdrawn, triggering the discharge of the Minister of
Health, the subsequent collapse of the governing coalition and deep political
crises within both governing parties.
3.4.2 Direct payments
Patients must pay the full price of services that are excluded from public
financing, such as certification of health for the purpose of employment, sports
or obtaining a driver’s licence (1997/18). The same applies to services that are
covered in principle but are actually delivered by a private provider who has
not been contracted by the NHIFA. By the same token, providers contracted
by the NHIFA are not allowed to charge extra for covered services (1997/9).