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

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Health systems in transition Hungary
In April 2009, the government decided to abolish the output volume limit
for inpatient and outpatient specialist medical services, which had been in place
since 2004, and to introduce a combination of a pre-fixed national base rate
combined with a floating fee element (EMAFT). This sparked a very serious
debate between the government and the hospitals and intense protests on behalf
of the latter that escalated in September 2009. Finally, the government and the
representatives of the hospitals agreed that, instead of replacing the outputbased
payment system with a predetermined global budget, the government
would abolish the EMAFT system and reintroduce the previous output volume
limit in the financing of specialist medical services.
Pharmaceutical care
There is a unified system of free pricing for all pharmaceuticals regardless of
prescription status. For reimbursed medicines, the price proposed by traders is
evaluated by the NHIFA, using external and internal reference pricing as well as
HTA for the evaluation of cost–effectiveness. The NHIFA finances pharmacies
and wholesalers with regressive and/or fixed mark-ups. Every hospital has the
autonomy to purchase the necessary medical products by tendering or public
procurement, once the product in question has been evaluated and assigned a
coverage status by the NHIFA. The cost of drugs for hospitals is financed by
the NHIFA through HDG payments. Patients are required to pay co-payments
for pharmaceuticals reimbursed by the NHIFA up to a certain percentage of
consumer prices and/or are reimbursed based on reference pricing (see section
2.8.4 for more detail).
3.7.2 Paying health workers
In the state-socialist health care system all physicians, nurses and midwives
were salaried public employees, and private practice was allowed only on a
part-time basis (1972/2). Public employment with salaries has remained the
dominant form of medical practice throughout the years of continued health
care reform, with the exception of entrepreneur family doctors, who contract
with both the NHIFA and local governments and are paid on a capitation basis.
Some medical doctors run private practices, usually as second jobs, and are
paid per on a fee-for-service basis by their patients, free from central regulation.
Most specialists are salaried public employees, who are guaranteed a minimum
level of salary according to a pay scale (1992/5) based on qualifications
and years of experience, but the number of specialists who work as private
entrepreneurs contracting with health care providers is increasing, especially
in the outpatient specialist care sector. Most clinical specialists still receive
informal payments from patients, but these are too unequally distributed to