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

Health systems in transition Hungary 155
is underfunded and short-staffed, and there are substantial regional disparities
in access to services (Research Institute of the State Audit Office of Hungary,
2009).
In terms of financing and payment, because rehabilitation services are
classified as chronic care they are paid for by patient-days (adjusted for the
complexity of the case) (1999/1). Since March 2008, however, providers that
do not meet the minimum standards – mainly related to human resources –
have been paid for with lower weights for the same case (2007/12, 2009/5).
Thus, in practice, rehabilitation services are paid according to the provider’s
staffing standards rather than the complexity of the case. This is an obvious
financial incentive for providers to develop their rehabilitation staff, but also a
disincentive to treat more complex cases, thus leading to risk selection. There
are plans to introduce a DRG-type system on the basis of the International
Classification of Functions, Disability and Health (referred to in Hungary as
homogeneous rehabilitation groups).
5.8 Long-term care
Long-term care is provided both by the health and the social sectors. In principle,
the location of service provision is determined based on the patient’s health
needs. In practice, however, the boundaries between the two sectors are quite
unclear. Indeed, service categories can overlap and people can be assigned
to the wrong setting, such as when long-term social care for the elderly is
provided in acute wards due to the shortage of places in residential homes.
Nevertheless, in line with the legal framework and the recommendations for
the amendment of the System of Health Accounts classification (International
Health Accounts Team, 2011), we describe the institutions of long-term health
(or nursing) care and social care separately, while subsequently discussing the
performance problems jointly.
5.8.1 Long-term nursing care
In the Hungarian health care system, long-term nursing care (LTNC) is one
category of chronic care, together with general chronic care, rehabilitation,
hospice and palliative care. There are different modes of provision (inpatient,
daytime hospital, outpatient and home care), which generally correspond to the
System of Health Accounts classification of long-term nursing care (“inpatient