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

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Health systems in transition Hungary
implemented starting in April 2007 (NISHR, 2007). This took place without
the government having previously published a discussion paper or special policy
paper for wider consideration, and several experts at the time criticized the law
for its lack of transparent methodology (Ágoston et al., 2009).
In the wake of this legislation, the total number of acute hospital beds was
reduced by 26% (to 44 215), some of which were transformed to increase
chronic, rehabilitative and nursing care capacity by 35% (to 27 169) (Vas et al.,
2009; NISHR, 2007). Five hospitals were closed down along with the acutecare
departments of another twelve hospitals. Moreover, four hospitals were
merged in a single state central hospital. The level of the acute care provided
by the hospitals was split into categories, such as priority hospitals (39 in total)
and territorial hospitals (77 in total) (NISHR, 2007). The priority hospitals,
which consisted of a heterogeneous group including large university clinics,
county hospitals and small municipal hospitals, accounted at the time for
approximately 50% of all hospital beds in Hungary (Vitrai, Kiss & Kriston
2010). They were intended to work with the most advanced technology and
with the best-trained physicians and to function as emergency centres providing
urgent care around the clock every day of the year. In contrast, the territorial
hospitals were intended to provide general acute care. In addition, 50 institutions
were allowed to provide only rehabilitative and nursing care (NISHR, 2007),
and the new regulation reshaped the catchment areas of all providers as well.
The capacities of outpatient care were frozen at the level of 31 December 2006
(Ágoston et al., 2009).
Capacity regulation of the providers had already been reorganized twice
since the mid-1990s (see section 2.2). The new regulation (2006/12) returned
to the pattern of the capacity regulation legislated in 1996 in two important
respects. First, the new system was introduced in both cases along with
deep downsizing of the hospital beds. Second, implementing and managing
capacity regulation was left to the stakeholders – that is, the county consensus
committees after 1996 and the regional health councils after 2006. Furthermore,
the decrease in the total number of beds seen in 2006 was 11%, which mirrored
the reduction that had taken place in 1996 (Ágoston et al., 2009).
The regional health councils are convened by the NPHMOS and consist of
representatives of the most important stakeholders, such as hospitals and the
NHIFA. By establishing this mechanism, the government aimed to give more of
a role to the stakeholders in monitoring unused capacity and to restructure this
capacity through systematic negotiation. The councils are also entrusted with
compiling regional health development plans. Unfortunately, the new system