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

Health systems in transition Hungary 131
• The family doctor performs several basic examinations, such as blood
pressure, blood sugar and ECG, which are available on site in his practice.
For laboratory testing, the patient is either referred to the laboratory
responsible for the family doctor’s primary care district (through the
territorial supply obligation), or the blood sample is taken on site and sent
in by the doctor’s office. A referral from the family doctor is necessary for
performing the tests.
• Once the patient has returned with the results, the doctor evaluates them
and makes a diagnosis. If further diagnostic or treatment measures are
beyond his competence, he refers the patient to an outpatient specialist,
which in the case of our example patient is a cardiology unit.
• With the family doctor’s referral slip in hand, the patient visits the
provider who delivers cardiology outpatient services under the territorial
supply obligation. This provider is located either within an independent
outpatient clinic or an outpatient unit attached to a hospital. Although
patients are entitled to choose their health provider and doctor in
accordance with the provisions of Act CLIV of 1997, the right to free
choice is constrained in many ways within the health insurance system
by other regulations and by user charges. Providers of secondary care are
not allowed to refuse treatment to patients within their catchment area,
but may do so for patients outside their catchment area who are seeking
elective interventions. If a provider has enough capacity, however, patients
living outside their catchment cannot be turned down either. Within
hospitals, patients may freely choose their physician, albeit subject to the
provider’s operational rules (1997/20). The choice of an inpatient care
provider and physician is subject to a 30% co-insurance, with a ceiling of
HUF 100 000 (about €360) (2006/9, 2006/17, 2007/4).
• In cardiology, a specialist coordinates the care, makes the final diagnosis,
determines the appropriate treatment, and decides which level of care
(inpatient or outpatient) is required for the patient. In Hungary, it is typical
for inpatient and outpatient care to be integrated – that is, they use the
same human resources and infrastructure within the same organization.
This being said, there are also a number of independent polyclinics.
• After the patient has completed specialist treatment, the specialist
prepares a discharge note, with which the patient returns to his family
doctor. From this point onwards, the family doctor is responsible
for coordinating the patient’s care according to the treatment plan
recommended by the specialist. Because the specialist’s attestation of
the diagnosis is valid for six months only, patients undergoing long-term