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

Health systems in transition Hungary 93
In addition to the main payment methods, special rules apply to certain
services, whose running costs are covered from separate sub-budgets of the
HIF. Patient transfers are paid per kilometre plus a fixed fee per patient; home
care is paid per home visit adjusted for the complexity of the case. Expensive
prostheses, implants and some other medical devices (pacemakers etc.) are
sometimes paid for separately, while the remaining costs of the intervention are
covered by HDGs. This also applies for some expensive procedures and drugs
(transplantations, extracorporal liver dialysis, oncologic drugs, etc.).
The government in power from 1998 to 2002 piloted the CCS, a project
aiming to address the shortcomings of incentives in the existing payment
systems. The concept of the CCS was that health care providers be given the
opportunity to take responsibility for the entire spectrum of care of a population
group (initially up to 200 000 people) (1998/26). These care coordinator
organizations could be hospitals, polyclinics or groups of family doctors and
were assigned a virtual budget by the NHIFA based on the number of people
in their catchment area multiplied by a risk-adjusted capitation fee. If the total
cost incurred during the year was lower than the virtual budget, the difference
was paid to the care coordinators and could be invested in improving services
or used for remuneration purposes. The project was criticized mainly for lack of
transparency as well as inequitable distribution (State Audit Office, 2008a) and
was subsequently abolished in December 2008, despite documented successes
during its first few years of operation.
Public health services
Public expenditure on public health services was 0.2% of GDP in 2008, which
was 2.6% of total health expenditure (OECD, 2010). The central government
and the NHIFA use different types of payment methods to finance these
services: the NHIFA finances MCH nurse services through prospective
capitation and fixed payments based on geographical considerations. Of the
total public spending on public health, the share of NHIFA finance was 28% in
2008. The largest share (48% in 2008) in financing public health comes from
the global budget provided by the Ministry of National Resources that gives a
global budget to the NPHMOS, which covers services for communicable and
non-communicable diseases (see also section 5.1).
The government spent 24% of total expenditure for public health services
under the intersectoral NPHP (see also sections 5.1 and 2.6) that aims to
coordinate and carry out various prevention and health promotion programmes.
Within the NPHP, the Ministry of National Resources awarded grants and gave
direct payments for prevention and health promotion activities amounting to