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

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176 Health systems in transition Hungary Intersectorality and public health In 2001, a 10-year public health action programme was launched with the aim of increasing the life expectancy of men and women to 70 and 78 years, respectively (2001/9). Coordinated by a project unit within the NPHMOS, the programme was continued and later expanded by the government after 2002. Known as the Johan Béla National Programme for the Decade of Health, it was accepted by the National Assembly in April 2003. Still in effect today, the programme has ambitious targets in four main areas – social environment, lifestyles, avoidable mortality and public health institutions – and focuses on cardiovascular disease, cancer (e.g. national screening programmes in breast, cervical and colorectal cancer), mental health, locomotor diseases, HIV/AIDS and risk factors such as smoking, alcohol, drugs, unhealthy diet and lack of exercise (2003/1). National screening programmes for breast (2002), cervical (2003) and colorectal cancer (still a pilot programme) were introduced within its framework (2003/8). Compared to previous plans, the novelty of the new programme was that it focused on the wider environment and determinants beyond the health sector. After the National Assembly stressed the importance of intersectoral, multilevel national collaboration, with a particular focus on non-communicable disease, in its resolution on the NPHP (2003/1), the Ministry of Health 2 set up an Intersectoral Public Health Committee, which was led by the State Secretary of the Ministry in 2003 and 2004, and subsequently by a Government Commissioner (Vokó, 2009). The necessity to incorporate the priorities of the NPHP into policy-making in all sectors was reinforced by the National Assembly once again in 2004 (2004/11). 6.1.2. Reforms of health system financing The lack of a stable and predictable flow of resources is arguably the most serious shortcoming of the Hungarian health system. The funding of the health system is strongly influenced by policy goals unrelated to health, such as labour and broader economic policy objectives. Moreover, the large deficit of the HIF, especially since 2004, has been a major driver of health system reforms, most of which have focused on cost-containment and on broadening the revenue base of the system. 2 As of 2010 called the State Secretariat for Healthcare within the Ministry of National Resources.
Health systems in transition Hungary 177 Revenue collection Various government programmes between 2002 and 2010 have focused on establishing a registration and monitoring mechanism to check whether patients had actually paid the necessary HIF contributions and were thus entitled to obtain health care services (Government of the Republic of Hungary, 2006). The system that was ultimately introduced in 2006 is located on site with the providers, who have thus assumed the monitoring function. Importantly, even if they have not paid their HIF contributions, patients cannot be denied necessary care; instead, the patients and the Tax Office are notified about the case for further proceedings (for more details see subsection Breadth of coverage in section 3.3.1). Despite problems related to delayed communication between the NHIFA and Tax Office, several reports published by the NHIFA and the State Audit Office show that the share of the population with an unclear registration status has declined to 3% (State Audit Office, 2008a). In 2005 a new type of hybrid tax/contribution called a “simplified contribution payment” was launched. It applies to individuals and small entrepreneurs working in media or in the arts and earning below a certain income ceiling (2005/6). Instead of paying regular HIF contributions or income tax, the employees and, when applicable, employers in these occupational groups pay a preferential contribution rate (see subsection General government budget in section 3.3.2). The stated aim of the measure was to support free debates of public issues in the media and arts, and to promote freedom of artistic activity. The HIF collects 1.8 billion HUF (around €6.5 million) from this source annually, which amounts to about 0.1% of its total expenditure. This measure well characterizes the fragmentation of revenue collection in a system in which the government applies policy measures that have little to do with overall health system goals. Since 2006, deep cuts in the HIF contribution rate paid by employers have led to a shift towards funding through general taxation, as has a redefinition of the central government contribution to the HIF using a new formula to account for non-contributing social groups (2007/11) (see section 3.3). Whereas in the late 1990s employer contributions accounted for 73.6% of HIF revenue (versus 11.3% for employee contributions), they accounted for only an estimated 16.1% (versus 29.6%) in 2010. Furthermore, the lump-sum component of the hypothecated health care tax was eliminated in 2010. At the same time, the total transfer from the central government budget, including deficit financing, is estimated to be almost five times higher in 2010 than it was in 1997. In short, general taxation has become as important as wage-related contributions as a source of revenue in the Hungarian health care system (see section 3.2).
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Health Systems in Transition Vol. 1
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Health Systems in Transition Péter
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Contents Preface
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Preface The Health Systems in Trans
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Acknowledgements The Health System
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Health systems in transition Hungar
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Abstract Hungary has achieved a suc
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Executive summary Introduction Hung
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1. Introduction 1.1 Geography and s
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18 NATIONAL/CENTRAL LEVEL REGIONAL
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3. Financing 3.1 Health expenditure
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10. Appendices 10.1 References Ád
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The Health Systems in Transition pr
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The European Observatory on Health
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