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

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Health systems in transition Hungary
5.4.2 Inpatient services
In 2009 Hungary had 153 hospitals with an inpatient care contract with the
NHIFA and a total of 71 800 approved hospital beds (NHIFA, 2010). Generally,
these hospitals provide inpatient care at the municipal, county, regional
or national levels, according to their level of specialization, which usually
coincides with the hospital’s catchment area. Hospitals that provide care in more
than one medical specialty, however, can have different specialization levels for
different specialties and consequently different catchment areas. Moreover, a
hospital can have different catchment areas for the same specialty, as do clinical
departments of university medical faculties, which have a local catchment area
for secondary care and a national catchment area for tertiary care within the
same specialty.
The principle of the Hungarian health care delivery system is that patients
must receive care at the lowest level of specialization that can provide
adequate treatment, and may be transferred to hospitals with higher levels of
specialization only if necessary (1997/9). Where a patient ends up in the hospital
system depends on the frequency of the disease, the severity or complexity of
the case, and the cost and complexity of the treatment.
Municipal hospitals usually offer main specialties, such as internal medicine,
obstetrics and gynaecology and surgery. According to the minimum legal
requirements, a hospital at the first level of specialization is obliged to cover
internal medicine, surgery and one other specialty, together with the basic
diagnostic facilities (ultrasound, X-ray, ECG, laboratory) (2003/15). Municipal
hospitals have the lowest level of specialization and the smallest catchment
areas. County hospitals usually cover the whole spectrum of secondary care,
providing additional specialties, such as haematology, immunology, cardiology
and psychiatry for the population of an entire county. For the basic specialties,
county hospitals usually have a local catchment area with the lowest level of
specialization and another catchment area covering the whole county, within
which they accept more severe or complex cases from municipal hospitals.
County hospitals may also provide tertiary care, such as open-heart surgery,
for the population of a region comprising more than one county. Finally, clinical
departments of university medical faculties and National Institutes provide
care of the highest level of specialization for the whole country, but university
clinical departments have local catchment areas as well.
The owners of health care providers are required by law to supervise the
management of their institutions (1997/20). There are no detailed regulations
governing the way that hospital management operates. Hospitals that provide