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

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Health systems in transition Hungary
3.7 Payment mechanisms
3.7.1 Paying for health services
Under the former state-socialist system, hospitals and other health care
institutions received a fixed, annual, line-item budget that was increased
by a certain percentage each year. The size of the budget was not linked to
performance but to input norms and it was subject to political influence. The
reforms of the 1990s have brought about significant changes in inpatient as well
as outpatient care. The payment system has become output-based and payment
mechanisms are geared to the type of service instead of the type of institution.
Patient capitation was introduced for family doctor services in 1992, while a
fee-for-service point system for outpatient specialist care, a payment system
based on HDGs for acute inpatient services, and payment per patient day for
chronic care were established in 1993 (1992/4, 1992/8). Payment methods for
various services are determined annually in the acts on the HIF budgets (1997/9),
while detailed regulations are provided in governmental and ministerial decrees
(1993/5, 1999/1). An overview of payment mechanisms is presented in Table 3.8.
Table 3.8
Provider payment mechanisms
Ministry of
National Resources
National Helath
Insurance
Administration
Private voluntary
health insurers Cost sharing Direct payments
Primary care – C, CP – – X
Outpatient
specialist care
– FFS FFS – X
Acute hospitals – HDG, IP FFS – X
Inpatient long-term
care
– PD – X X
Long-term nursing
care
– PD, FFS – – X
Dentists – FFS – X X
Pharmacies – FFS – – X
Public health
services
PF C FFS – X
Pharmaceuticals – FFS FFS X X
GB: Global budget C: Capitation
CP: Case payment PF: Project financing
IP: Itemized payment
FFs: Fee-for-service
PD: Per diem