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

94
Health systems in transition Hungary
2.2% of total spending whereas other ministries and government agencies
provided 22% of total expenditure on public health services (Ministry of Health,
2008). Finally, EU grants are increasingly used to finance public health services
under the Social Renewal Operational Programme. However, in 2010, amounts
awarded for health promotion (HUF 4.6 billion or €16.6 million total) were
fairly limited compared to those allocated to health infrastructure (more than
HUF 107 billion or €385.6 million) (Antonyi, 2011).
Tobacco and alcohol taxation is a significant source of income for the central
government, but there is no specific allocation to public health services. The
Ministry of National Resources recently recommended using excise tax to
finance public health services as an alternative, but there has not yet been a
government decision on this matter (Ministry of National Resources, 2010).
Primary/ambulatory care
Family doctors are financed with mixed payment methods that include
prospective and retrospective elements. Capitation payment was introduced
in 1992 for their services (1992/4). In 2009, the NHIFA paid 70% of the total
expenditure on family doctor services through prospective capitation payments
(NISHR, 2011b). People are allowed to choose their family doctors freely
(see also section 2.9.2), and the number of registered individuals per practice
(practice list) is the basis of general practice financing. The practice income
is made up mainly of capitation payments with an additional fixed amount
depending on the size and location of the practice as well as case payments for
non-registered patients, which represented 29.4% of NHIFA expenditure on
family doctors in 2009.
Capitation payments are based on the size of the practice list, which must be
updated regularly by the family doctor to allow for any changes (for example
due to death or migration). They are adjusted to the age composition of the
patient pool and the qualification and work experience of the physician. The
population is divided into five groups: for a person up to 4 years of age, family
doctors receive 4.5 points; between 5 and 14 years 2.5 points; between 15 and
34 years 1 point; between 35 and 60 years 1.5 points; and over 60 years 2.5
points. Above a certain number of points (2400 for adult or child practice, and
2600 for mixed practice), the family doctor does not receive the full capitation
payment, to prevent the negative impact of an unmanageable practice size on
quality of care. Different limits apply if the practice is not single-handed. The
total number of points is multiplied by 1.2 if the family doctor has a relevant
qualification (specialization in family medicine or internal medicine for adult
practices or paediatrics for child practices). The factor is 1.1 if the family doctor