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

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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.
Health systems in transition Hungary 141 under the Regional Operative Programmes, and the building of new polyclinics under the Social Infrastructure Operative Programmes of the New Hungary Development Programme, financed by EU structural funds (2006/6). In the former, day care was optional, while in the latter it was a compulsory component. Most of these new capacities are to be operational in 2011. In addition, the government in power from 2006 to 2010 used special payment arrangements to support day care. Since 1 June 2008, hospitals have been allowed to convert a portion of their billable fee-for-service points (that is, the maximum number of points for which a provider is eligible for SHI financing) for outpatient specialist care to HDG points (2008/3). This measure was not entirely successful, as only a fraction of fee-for-service points was converted (70% and 40% of fee-for-service points remained unused in 2008 and 2009 respectively) (State Audit Office, 2010). As a result of the aforementioned measures, the number and share of day-care cases have been increasing, especially in the past four years. Nevertheless, there is still no specific strategy with exact targets for day care in Hungary, and the proportion of same-day surgery is still very low compared, for example, to the UK, Finland, Denmark and the Netherlands (State Audit Office, 2010). Only 10.8% of elective surgical procedures were performed as day cases in 2008 (OECD, 2010). In 2009 a total of 129 469 day-care cases (121.4 cases per 10 000 inhabitants) were reported in Hungary (HCSO, 2010f), and some two-thirds of publicly financed health care providers reported offering day-care services (NHIFA, 2010). 5.5 Emergency care Emergency care is built around primary care (family doctors, out-of-hours services), polyclinics, inpatient care facilities (night duty), emergency medical services provided by the National Emergency Ambulance Service and, as a recent development, A&E departments of hospitals at different levels of specialization, as well as a web- and telephone-based medical counselling service known as DrInfo. Act CLIV of 1997 on Health defines and differentiates between out-of-hours services (night duty, Article 93) and emergency medical services (medical rescue, Articles 94–96). Emergency medical services are provided to patients in need of immediate care and include (a) the care provided by an authorized provider at the place of the incident, (b) transportation to the closest service provider who can provide adequate care and (c) the care provided during transportation (Article 94). A few special kinds of emergency medical services
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Health Systems in Transition Vol. 1
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Health Systems in Transition Péter
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Contents Preface
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Preface The Health Systems in Trans
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Acknowledgements The Health System
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Health systems in transition Hungar
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xiv Health systems in transition Hu
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Abstract Hungary has achieved a suc
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Executive summary Introduction Hung
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1. Introduction 1.1 Geography and s
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18 NATIONAL/CENTRAL LEVEL REGIONAL
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3. Financing 3.1 Health expenditure
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8. Conclusions Since the mid-1990s,
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10. Appendices 10.1 References Ád
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The Health Systems in Transition pr
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The European Observatory on Health
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