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

Health systems in transition Hungary 171
does not have a clear process of health needs assessment, and the councils
lack the proper policy capacities and authority (Tótth, 2008). Furthermore, no
monitoring process has been put in place to evaluate how far the objectives
of this reform have been achieved. Some observers have stated that the
government’s measures did not lead to a more equal distribution of capacities
(Vas et al., 2009). Moreover, the impact of the reform on efficiency has not
been analysed. Several projects to evaluate the impact of the reform on quality
and on financial protection have been initiated, with the involvement of WHO
experts, as part of the Biennial Collaborative Agreement through the WHO
Country Office in Hungary. These studies are expected to be completed in the
second half of 2011.
Regarding the impact of capacity regulation on the financial sustainability
of the system, however, it seems clear that the health system has not been
strengthened. Indeed, the system of prospective payment, which has served
as the cornerstone of the Hungarian health financing system since 1993 (see
subsection Specialized ambulatory/inpatient care in section 3.7), had almost
collapsed by 2009, and the protest by hospitals against the financial restrictions
of the government has intensified greatly. A new lobby organization, the
Strategic Alliance for Hungarian Hospitals, was created to increase pressure
on the government to improve health system financing. Moreover, Hungarian
hospitals initiated a “green flag movement” in 2009 to inform patients of their
financial situation and to put pressure on the government to ease the financial
restrictions.
Ownership and management of health care providers
With the stated aim of increasing the efficiency of health care providers, the
government announced in June 2006 that it would introduce measures to
encourage the conversion of providers from public to other forms of ownership
that would entail more private involvement (Government of the Republic of
Hungary, 2006). The government also pledged that regulations affecting public
providers would be modified so that their business operations would more
closely resemble those in the more competitive business sector (Government of
the Republic of Hungary, 2006). The link between the reform plans and general
health objectives, however, was not clarified.
Previous attempts at creating transparent regulations governing the
involvement of private providers had failed for a variety of reasons. The
government in power from 1998 to 2002 chose to take a corporatist approach,
preserving the public hospital system and allowing health care providers more
discretion in their allocation of resources. The first law to this effect was crafted