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

Health systems in transition Hungary 173
and despite its original plans for five to seven years of business cooperation.
At the same time, more and more local governments with similar outsourcing
contracts were reported to be lending significant amounts to their health care
providers to maintain their operations.
The failure of private companies in running public providers has meant
a serious failure of the business model whereby local governments retain
ownership of a facility but outsource the provision of services or management
to private individuals or companies – otherwise known as “functional
privatization” in Hungary. In 2009, the State Audit Office published a study
on the outsourcing of hospital services and management, which followed an
earlier study on the privatization of secondary and tertiary care health services
published in 2006. One of the conclusions of the 2006 report was that a lack of
health policy guidance and regulation had resulted in the privatization process
being governed by private companies rather than by public authorities (State
Audit Office, 2006). The 2009 report confirmed this finding (State Audit Office,
2009b). The role of private capital in the provision and management of services
in the Hungarian health care system remains an unsettled policy issue.
Coordination in health care
During the past decade, the most comprehensive measure in the area of
health care coordination in Hungary was the CCS, which was launched as
a pilot program in 1999 and was in operation until late 2008. The CCS was
launched to address the shortcomings of health system monitoring and the
various payment systems by employing new financial incentives. The content
of the reform, however, was not developed in discussion papers or in a detailed
policy proposal, and no specific regulation was prepared. Rather, the National
Assembly approved the launch of the CCS by passing a brief amendment to
Act XCI of 1998 on the Social Insurance Funds’ Budget of 1999, which was
the same law that shifted the responsibility for collecting HIF contributions to
the Tax Office.
In essence, the CCS offered health care providers the opportunity to take
responsibility for the whole spectrum of care for a population group, initially up
to 200 000 people (1998/26). The idea behind the pilot was to provide financial
incentives to health care providers to coordinate their activities across levels of
care for a population living in a geographically defined area, using the health
care utilization data accumulated at the NHIFA.
Although the CCS showed some similarities with managed care in the US
and general practitioner fundholding in the UK, it had the following innovative
features: