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

Health systems in transition Hungary 147
Table 5.1
Number and main types of pharmacies in Hungary, 2000–2010 (selected years)
Type of pharmacy 2000 2006 2008 2009
2010
(23 August) a
Public 1 999 2 010 2 351 2 412 2 441
– branch pharmacy 604 650 652 655 650
– single-handed pharmacy 298 278 253 248 250
Institutional (hospital) 147 143 130 130 122
– with a community retail unit 46 73 71 74 80
Sources: HCSO, 2010f; a Government of the Republic of Hungary, 2010b.
Note: Single-handed pharmacies are translated in the HCSO, 2010f publication as “magistral pharmacies”, but this is incorrect because
these pharmacies do not dispense magistral products.
In addition to the types of pharmacies shown in Table 5.1, there are three
other categories of pharmaceutical retail (Government of the Republic of
Hungary, 2010b). First, the over-the-counter market was liberalized in 2006
by allowing the sale of certain over-the-counter drugs outside of pharmacies
(2006/8). In 2010, about 470 types of over-the-counter medicines were available
in about 600 retail units (mostly petrol stations, supermarkets, drug stores and
beauty shops); only 1% of total over-the-counter retail sales took place in such
locations, however. Second, through the active inpatient care sub-budget of the
HIF, the NHIFA is the direct purchaser of certain very expensive drugs (e.g.
target therapies in oncology such as trastuzumab, bevacizumab and pemetrexed),
which are supplied to hospitals by the manufacturers on a contractual basis, as
part of which the NHIFA stipulates the number of patients that can be treated.
Approximately 3–4% of the pharmaceutical sub-budget of the HIF is spent
this way. Third, only a very small fraction of pharmaceutical retail takes place
through the internet and home delivery, which is still operated by pharmacies.
Before 2006 the ownership and market structure of pharmaceutical
retail was developed based on the ethical model of corporate responsibility.
Privatization was guided by Act LIV of 1994 on the Establishment and Rules
of Operation of Pharmacies, according to which only self-employed private
entrepreneurs and limited partnerships were allowed to operate community
pharmacies, with the additional requirement that the unlimited liability
partners of the limited partnerships must be pharmacists with at least a 25%
share (Article 36). Community pharmacies had to be established and managed
by pharmacists with a special licence, the so-called personal right (személyi
jog) (Article 15), a concept similar to the “practice right” in primary care (see
section 5.3). In partnerships, one of the unlimited liability partners had to
be a pharmacist in possession of this special licence (Article 29). With these
measures, the government aimed to ensure that pharmacists had a decisive role