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

168
Health systems in transition Hungary
transparency (2008/7). This was the third and most elaborate attempt since
the early 1990s to introduce a system of multiple, competing health insurers to
Hungary. (For details on the two previous attempts, see section 2.2.)
A bill introducing managed competition to the SHI system was approved by
the National Assembly in December 2007, but vetoed by the President shortly
thereafter. In February 2008 the National Assembly overrode the presidential
veto and passed the bill in the face of widespread public protest. At the same
time, the main opposition parties initiated a referendum, which was held in
March 2008, on user charges for physician visits and hospital stays and on tuition
fees in state-funded higher education. By an overwhelming majority of more
than 80%, voters approved a measure revoking both measures. In the meantime,
the opposition parties had signalled their intention to hold a referendum on the
legislation for managed competition in September 2008. Expecting that this
would have the same outcome as the referendum held in March of that year, the
National Assembly repealed the act in May 2008. This created what is most
likely an unprecedented case in the history of the Hungarian lawmaking, with
the same parliament approving a law twice and then repealing it within the
space of six months. This situation caused the Alliance of Free Democrats to
leave the governing coalition, leading to a break-up of the government and the
formation of a minority government by the Hungarian Socialist Party.
If the managed competition model had been implemented, the NHIFA/HIF
would have been replaced with 22 joint-stock companies. In each company,
49% of the stocks would have been sold to private investors and 51% would
have remained in state ownership. The minority private stockholder, however,
would have nominated the CEO and had deciding power to influence daily
management. It would have been possible for a single investor to have a stake in
more than one company, but only if the total number of individuals insured by
these companies did not exceed 2 million. Insurers would have been expected
to compete for enrolees through the quality of their services, and they were
to form joint commissions at the national level to advise the government in
purchasing decisions.
Administrative costs would have been limited to 3.5% of the revenue, which
is approximately twice the percentage currently incurred by the NHIFA.
The HISA
With the stated aim of increasing accountability and transparency, a plan
to establish the HISA was presented in June 2006 (2006/10). Doing so was
considered by the government to be a precondition for introducing managed
competition to the health insurance system (Government of the Republic of