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

Health systems in transition Hungary 97
example, generic drug prices were used for HDG calculation instead of actual
cost data from hospitals or from the introduction of new, more cost-effective
technologies.
The Information Centre for Health Care (Gyogyinfók) launched a pilot
project to collect cost data in hospitals for the adaptation of the United States
DRG system in 1986 (1987/1). The first version of HDGs was developed on
the basis of cost data from 500 000 cases of 28 participating hospitals, and
was introduced countrywide in July 1993 (1993/5). Initially, the base rate was
unique to each hospital. It was calculated for each institution on the basis of
its previous budget and output, and the differences were gradually decreased
until the national average was reached in 1998 (1995/9, 1996/12). Government
Decree No. 13/1998 (I. 30.) Korm. introduced the uniform national base rate
in March 1998, with the provision that it can be recalculated if output exceeds
budget reserves (1998/1). For a short period of time, the government used a
supplementary fixed element in hospital financing, unrelated to hospital
performance, which was eventually abolished in 1998 (1996/12, 1998/26).
These gradual changes allowed hospitals to phase in the new system of
payment in a more acceptable and less disruptive way. It should be noted,
however, that the transitional system of individual base rates (unique to each
hospital), and of retaining parts of the historical budget put the most efficient
hospitals at a disadvantage. For instance, in the case of the HDG payment
system, individual base rates were calculated on the basis of the previous
historical budget of each hospital, which was divided by the HDG points earned
by the hospital in a pre-introductory period. This means that those hospitals
that produced the most output (in terms of HDG cost weights) from the lowest
annual budget had the lowest individual base rate.
The introduction of the output volume limitation for hospitals possibly led
hospital management to introduce measures that further decreased hospital
costs and therefore limited provision of services, thus lengthening waiting
lists. In 2009, the Ministry of Health 3 proposed amendments to improve the
flexibility of capacity distribution between inpatient and outpatient facilities,
and between inpatient curative care and inpatient long-term care (2009/5). The
number of patients whose treatment will be covered will be redistributed each
year on the basis of proposals by the HIF. If some allocated capacities are not
utilized, they can be transferred to another institution.
3 As of 2010 called the State Secretariat for Healthcare within the Ministry of National Resources.