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

5. Provision of services
Health care delivery is based on the constitutional obligation of the
state to make health services available to all eligible residents. At
the heart of the system is the territorial supply obligation, which
divides responsibility for service delivery among local governments according
to geographical areas and levels of care: municipalities are responsible for
providing primary care and county governments are responsible for providing
specialist health care services within their respective jurisdictions.
There are cases in which municipalities are allowed to provide outpatient
specialist and inpatient care. Indeed, according to the principle of subsidiarity,
county governments may not refuse to pass on the responsibility for service
provision to the municipalities if the latter are willing to accept it. Furthermore,
the territorial supply obligation determines the size of health care providers’
catchment areas, which can vary with different levels of care and types of
services. For instance, there are municipal hospitals that provide secondary
care not only to the inhabitants of the municipality concerned, but also to the
neighbouring population. Similarly, large county hospitals provide tertiary care
in certain medical specializations to the population of more than one county.
To understand fully how the delivery system operates in Hungary, however,
two further distinctions must be made. First, the territorial supply obligation
does not require local governments to deliver health services themselves; they
are allowed to outsource service delivery to private providers, who deliver
the services in a health care facility and with equipment owned by the local
government. Referred to as “functional privatization”, this arrangement is
the predominant form of service provision in primary care and has become
increasingly common in secondary care since the late 1990s. Second, whether
public or private, the owners of health care facilities that provide services
under the territorial supply obligation are responsible for keeping the assets in
working order – that is, for covering the capital cost of services. This principle
5. Provision of services