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

Health systems in transition Hungary 95
has no relevant qualification, but has at least 25 years of work experience in
primary care (1999/1). Family doctors receive the calculated practice income
directly from the NHIFA, if they are a private entrepreneur with a valid contract.
If they are a salaried employee of the local government, the NHIFA transfers
the capitation payment to the latter, which is responsible for salary payment.
In 2009, the government introduced a performance bonus payment system
for family doctors, based on quality indicators. Family doctor services have to
reach a certain minimum score measured by the NHIFA by means of selected
quality indicators in order to get rewarded. The government spent HUF 300
million (€1.1 million) for this purpose in 2010 but, as of April 2011, the Ministry
of National Resources is scaling up the programme, revising its methodology
and setting aside HUF 3 billion (€10.9 million) for potential financial rewards
(Borbás & Mihalicza, 2011).
Outpatient specialist care
Most outpatient specialist services are financed by fee-for-service points,
based on the German point system. Each procedure is assigned a number of
points on the basis of its complexity and resource requirements. Providers
report their monthly activity data with patient-level detail, including codes
of procedures performed, to the regional branches/offices of the NHIFA. The
payment process is carried out by central offices of the NHIFA. Up to the year
2000, performance points used to be added up nationally and the monetary
value of 1 point was calculated by dividing the predetermined sub-budget
(kassza) by the total number of points. Payment was made according to the
points collected, multiplied by the calculated national monetary value of 1 point.
These procedures allowed effective cost-containment. Between the second half
of 2000 and 2003, the monetary value of 1 point was fixed in advance and part
of the sub-budget was put aside at the beginning of each year to compensate
for output increases and seasonal variations. The money value of 1 point was
recalculated only if this reserve was exhausted.
Since the beginning of 2004 a new measure of volume regulation with
degression was applied to contain output inflation (2003/25). Providers were
eligible for full reimbursement for only 98% of their performance in the
preceding year. If a provider in a given month produced more points than that,
the excess points up to 5% were reimbursed at 60%, between 5% and 10% at
30%, and above 10% at 10% of the monetary value of 1 point. This system
was in place until 2006, when the government introduced an even stricter
cost-containment measure. Since 2007 excess points above the providers’ own
output limit are not reimbursed at all (see also section 6.1). A transition period