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

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Health systems in transition Hungary
was allowed for outpatient specialist care providers. Initially they could retain
70% of their previous historical budget and only the rest of their income was
calculated according to the collected fee-for-service points. The share of the
historical budget decreased from year to year, until the entire income came
from fee-for-service points produced.
Inpatient care
Inpatient services are reimbursed according to the type and severity of the case.
Since 1993, an HDG-based retrospective payment system is used to reimburse
acute-care, same-day surgery, certain types of treatment (such as chemotherapy)
and emergencies (> 24 hours), with the exception of some tertiary care services,
which are paid by the central government (see section 5.4 for more detail). A
few high-cost medical interventions, such as bone marrow transplantation, are
reimbursed on a case basis. Chronic (long-term) care is paid on the basis of
patient-days adjusted for the complexity of the case.
The essence of the HDG system is that it classifies inpatient cases into
a manageable number of categories on the basis of their medical features,
complexity and costs. The current version of Hungarian HDGs has 26 main
groups, which are themselves divided into hundreds of smaller groups. Each
group has an assigned weight (or number of points), which is higher for more
complex and costly cases. Hospitals have to report their discharged cases
monthly, and the reported cases are grouped into HDGs at the Department of
Financing Informatics of the NHIFA (formerly known as Information Centre
for Health Care, or Gyogyinfók), which operates the system. This procedure
determines the hospitals’ monthly output in terms of HDGs, and the NHIFA
pays according to the total number of HDG points multiplied by the monetary
value of 1 point, the so-called national base rate. The national base rate is set
in advance by the NHIFA for one year and it applies to all hospitals equally.
In order to facilitate cost-containment, the acute inpatient care sub-budget of
the HIF is also capped nationally, and the same techniques have been used to
prevent overspending as in the case of outpatient specialist services.
The current system has been developed over an 18-year period and HDGs
are revised continuously to adapt to changes in medical practice and to support
strategic purchasing (1998/2, 2001/1). It is worth noting that the HDG system has
been used for implicit strategic purchasing, which means that cost weights were
in some cases set higher or lower than the actual average cost of the services in
the relevant HDG group in order to motivate providers to increase or decrease
volume of a particular case or shift to alternative treatment modalities. For