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

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Health systems in transition Hungary
Second, Hungary has a large number of sites with thermal and medicinal
waters, and range of medicinal spas provide balneotherapy and other
rehabilitation services in an outpatient (and, more recently, in a daytime hospital)
setting, mainly for patients with locomotor conditions. The National Chief
Directorate of Health Resorts and Medicinal Spas registers the relevant natural
treatments (including mineral waters, medicinal waters, medicinal mud and
medicinal gas), health resorts (geographic areas in which the relevant natural
treatments can be found) and the service providers that provide these treatments
for rehabilitation and curative purposes (such as medicinal spas, sanatoria,
medicinal grottos and spa hotels) (1999/13). Two main service categories are
defined by a ministerial decree: (1) balneotherapy services (such as medicinal
bath, medicinal mud-pack, medical massage, weight-bath, carbon-dioxide bath,
under-water jet massage) and (2) medicinal swimming for children (2004/9).
The decree regulates the minimum professional standards for each service type
and the rules of utilization. Only services prescribed by an authorized specialist
(that is, a rheumatologist, physiotherapist, orthopaedist, rehabilitation specialist
or traumatologist) and for listed indications are subsidized through the HIF
and require a provider who has a valid contract with the NHIFA (Article 3
and Annex 5, Article 12). The subsidy is limited to two eight-week courses of
treatment per calendar year with fifteen treatment episodes per course (Articles
5 and 8). The extent of the SHI subsidy is also determined by a ministerial
decree (2007/6).
Third, the most complex rehabilitation services are provided by the National
Institute of Medical Rehabilitation, which serves the entire population. The
Institute also carries out research and organizes professional education and
training. It has 50 acute-care beds, 347 rehabilitation beds and 60 daytime
hospital beds, and it allocates 773 hours per week for outpatient specialist
services. There is an ongoing renewal project for buildings and medical
infrastructure, which started in 2000 and should be completed in 2011.
In 2009, there were 9950 rehabilitation beds in Hungary in total, or 9.9
beds per 10 000 population (HCSO, 2010f). This was the result of a substantial
capacity increase in 2007, as part of which entire acute inpatient care hospitals
were transformed to chronic care/rehabilitation hospitals, leading to an increase
in the latter category of some 3000 beds. This restructuring of service delivery
aimed at supporting good-quality rehabilitation services. Nevertheless, the
reform has been criticized, mostly because the necessary infrastructure and,
more importantly, qualified human resources are still not available, and because
complex rehabilitation is not well coordinated; according to a study by the
Research Institute of the State Audit Office of Hungary, medical rehabilitation