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

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Health systems in transition Hungary
and hospitals owned by churches or charities; these private non-profit providers
are integrated into the main system of financing and service delivery (NHIFA,
2010). As part of the government’s plan to rationalize the service delivery
structure, the NHIFA has contracted with private profit-making providers for
the provision of same-day surgery as well (see also section 5.4.1).
5.4.1 Outpatient specialist services
According to the aforementioned provider typology, outpatient specialist
services are provided by polyclinics, dispensaries, municipal hospitals, county
hospitals, clinical departments of universities, National Institutes and health
care institutions of other ministries (for example, the Military Hospital – State
Health Centre under the Ministry of Defence).
Initially, polyclinics employed specialists who worked exclusively in
outpatient care. In the early reform phase in the 1990s, the objective was to
integrate polyclinics partly into hospitals and partly into primary care. Instead
of the three-pronged organization of the Semashko-style health care system
during the communist era, integration would have made a two-pronged system
of primary care and specialist care. The integration policy did not work,
however, leaving several polyclinics that are still organizationally independent.
Dispensaries were established during the communist regime. They provide
outpatient care to chronically ill patients with pulmonary, dermatological and
sexually transmitted diseases, people with alcohol and drug addiction, and
patients with psychiatric disorders. In addition to this chronic outpatient
specialist care, dispensaries implement screening programmes in their
respective specialties and, additionally, for hypertension, diabetes, cancer and
kidney diseases. In 2008 there were 170 dispensaries in Hungary for pulmonary
disease, 125 for dermatological and venereal diseases, 135 for psychiatric
disorders and 66 for addiction treatment (HCSO, 2010f).
As can be seen in Fig. 5.1, each person in Hungary had an average of 11.95
outpatient contacts in 2009, which was third among the countries of central
and south-eastern Europe after Slovakia (13.03) and the Czech Republic (13.00),
and almost twice the EU27 average. High utilization rates in the outpatient
specialist sector would not be undesirable if unnecessary hospitalization was
avoided as a result. However, acute hospital admission rates in Hungary are
also high (17.94 per 100 inhabitants compared to 15.66 for the EU27 average
in 2008), albeit following a decreasing trend after the output of hospitals and
outpatient specialist providers was limited by the government in 2006 (WHO
Regional Office for Europe, 2011) (2006/5).