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

Health systems in transition Hungary 111
One of the main legacies of the Semashko-style system in place during the
communist era was an oversized hospital sector, which came to be considered
inefficient and inequitable (see section 7.5.2), leading to calls for restructuring
and downsizing. In the first phase of reforms in the mid-1990s, the government
introduced a DRG-based hospital payment system for acute inpatient care
and per diem payments for chronic inpatient care, as well as a three-member
structure for top hospital management, according to which a financial director,
medical director and nursing director managed the institution together. These
measures did not produce significant structural reorganization in the hospital
system, but it has to be noted that a uniform base rate was not introduced until
1998 (1996/14).
The next government attempted to address the issue more directly. First,
as part of the restrictive package of 1995, the Ministry of Welfare 1 became
responsible for bed reduction decisions by determining the capacities to be
contracted for under the territorial supply obligation by local governments.
A total of 8000 beds was removed from the system in 1995 (1995/5), but the
decision-making process was found to be unconstitutional by the Constitutional
Court (1995/13), which ordered the government to develop a more systematic
method for applying the territorial supply obligation. The 1996 Capacity Act
determined the maximum number of beds and outpatient consultation hours
per specialty and per county based on a formula that aimed at representing the
health needs of local populations (1996/4). The Act was expected not only to
reduce the number of beds considerably but also to produce a more equitable
geographical distribution. Its implementation was left to the county consensus
committees summoned by the NPHMOS and comprising representatives
of local health care providers such as hospitals, the local branches of the
Hungarian Medical Chamber and county offices of the NHIFA (see section
2.2). In counties where beds had to be reduced based on the formula, the county
consensus committees had to agree which provider would give up how many
beds. As a result, the number of beds decreased by another 9000 in 1997, and
remained at around 80 beds per 10 000 population until 2006. The government
also endorsed cost-effective forms of care, including same-day surgery and
home care. For instance, in 1996, a separate HIF sub-budget was created for
home care services, for which HIF expenditure was also increased (see also
section 5.8).
As a result of all these changes, the number of acute hospital beds was
reduced by 20% between 1992 and 1997 and the number of hospital beds for
chronically ill patients was also reduced by 17%, according to national statistics.
1 As of 2010 called the State Secretariat for Healthcare within the Ministry of National Resources.