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

140
Health systems in transition Hungary
inpatient care and have performed a larger number of operations, and patients
within a polyclinic’s catchment area must be able to access its services within
30 minutes by car.
In the first phase of payment reforms in the mid-1990s, parallel to the
introduction of the Hungarian adaptation of the DRG system, 13 diseases and
13 interventions were defined that could be treated/performed in the outpatient
setting by inpatient care providers (1994/1). Since then, several modifications
have been made in terms of the clinical, organizational, regulatory and payment
frameworks of day care so as to improve its implementation, which has been
recognized as too slow by policy-makers. In particular, measures were taken to
shift more and more potential day cases from the hospital into the ambulatory
care setting. Between 1994 and 2010, the scope of eligible interventions has
been modified (in most cases expanded) many times, most recently in May 2010
(2010/3).
In late 2010, a total of 340 interventions (mainly surgical procedures,
but also some diagnostic and other therapeutic services) were eligible to be
performed on a day-care basis; these spanned the fields of general surgery,
orthopaedics, gynaecology, gastroenterology, cardiology, urology, proctology,
dermatology, ophthalmology, otorhinolaryngology and neurology (1993/6). Day
care is paid by HDGs and these are separately defined in a ministerial decree
(see section 3.7.1 for information on Hungarian DRGs) (1993/6).
The government also supported the expansion of day-care capacities by
means of various projects, the EU structural funds’ sponsorship of infrastructure
development and the provision of extra financing for increased cases attended
to (in 2003 and 2007). In the 2003 pilot project, eight service providers, five
public and three private, were contracted for 16 750 extra cases to be treated
over a two-year period between 2004 and 2005 (2003/2). In 2007, 5% of the
financial resources freed as a result of the 2007 downsizing of acute inpatient
care capacities were reallocated to the provision of day-care services (2007/3).
Altogether 104 providers submitted applications to the tender of the NHIFA, and
22 500 HDG points and 66 964 cases were distributed among the 47 winners.
In addition, the Ministry of Health 4 distributed extra output volume points
(expressed in HDGs) for day-care cases in 2008 from the so-called “ministerial
pool” (a certain percentage of the total output volume in a given year has been
set aside for the Ministry to distribute at its own discretion). Infrastructural
development was also supported by the government with conditional and
matching grants, most importantly for the refurbishment of existing polyclinics
4 As of 2010 called the State Secretariat for Healthcare within the Ministry of National Resources.