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

164
Health systems in transition Hungary
decisions and acts on behalf of the patient in accordance with the patient’s
abilities. In 2008 a total of 50.4 people per 10 000 inhabitants in Hungary were
reported to be under guardianship (HCSO, personal communication, 2010).
5.12 Dental care
With a few exceptions (removable dental prostheses for persons aged 18–60;
technical dental costs for people under 18, students in a full-time course of
studies and for people over 60; dentures for people under the age of 18, all of
which require co-payments), most dental services are available free of charge
within the single-payer health insurance system (1993/5, 1997/15, 1997/18,
2003/15). Dental care is divided into three services: (1) dental primary care,
including, among other things, dental screening, school dental services and
dental services for pregnant women, (2) dental specialist care and (3) dental
out-of-hours services. Dental primary care is organized on a territorial basis
similar to that for family doctor services, but unlike family doctors, patients
are not allowed to choose their primary care dentist freely.
Dental care is reimbursed using a mixed payment system consisting of a
fixed fee and a fee-for-service point system, the latter being the same as that
used for all other outpatient specialist services (1997/19, 1999/1). The fixed
component of the payment for dental primary care is a capitation payment
adjusted for the age structure of the population served (calculated in terms of
points and weights), and it is very similar to the capitation of family doctor
services in so far as the fee paid per capitation point decreases above a certain
number of capitation points. In the case of dental specialist services, there are
fixed numbers of capitation points for 30 hours of surgery per week, and they
decrease proportionately for fewer weekly hours of surgery. The capitation fee
(HUF per point) is set in a governmental decree. Finally, in the case of dental
out-of-hours services, the fixed fee (defined as a lump sum in HUF) depends on
the number of inhabitants (fewer than 50 000; 50 000–100 000; over 100 000)
and the number of duty hours per day (1999/1).
In Hungary, private provision is dominant is dental care. The development
of private dental care capacities was facilitated by cross-border dental care
and health tourism in general. The phenomenon started in the early 1980s, and
was originally limited to the border regions with Austria. According to certain
studies, Hungary is the target country for over 40% of all dental tourism in
Europe, with about 63 000 patients visiting Hungary every year for dental
treatment. Patients come mainly from the UK (30%), Ireland (20%), France