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

Health systems in transition Hungary 179
Provider payment methods
As a part of cost-containment efforts, and in addition to the existing DRG-type
system in place in inpatient care and the fee-for-service payment methods used in
outpatient care, a limit on the volume of billable services was introduced in 2004.
Known in Hungarian as a “performance volume limit” (teljesítmény volumen
korlát) – “performance” here meaning “output” rather than “outcome” – this
artificial limit was calculated as 98% of a hospital’s or outpatient department’s
total output in 2003. Until June 2006, a degressive scale was applied for services
delivered beyond the limit (see subsection Specialized ambulatory/inpatient
care in section 3.7.1). After July 2006, the baseline volume was reduced to 95%
of the 2003 output total, and the degressive scale was eliminated completely.
This meant that when a hospital or outpatient centre provided health care
services beyond the ceiling, they did not received additional reimbursement.
Because this led small hospitals to refer their “over the limit” patients to bigger
hospitals, this put the large university clinics (university teaching hospitals) at
a disadvantage.
This strict limit led to a difficult financial situation for hospitals and forced
hospital management to introduce measures, such as increasing the length of
waiting lists, to reduce expenditure and the volume of services provided. In
April 2009, the government decided to eliminate the aforementioned limit,
albeit only for inpatient services and for specialist outpatient services. For these
two groups of providers, the previous payment mechanism was replaced with
one that combined a predetermined national base rate and a floating fee based
on the volume of services provided (see Specialized ambulatory/inpatient care
in section 3.7.1). This change was likely the main reason that provider payment
system almost collapsed in mid-2009. A plan to introduce a predetermined
global budget was scrapped after weeks of discussions with representatives of
the providers. Instead, the previous system, with its strict limit on the volume
of billable services, was reintroduced in October 2009.
Private expenditure on health
Although the government programme presented in 2006 did not mention user
charges for the health care services by name, it did declare the intent of the
government to determine which services would be excluded from HIF coverage
and made available for a fee (Government of the Republic of Hungary, 2006).
In the summer of 2006, the government presented, as an alternative option for
debate, the introduction of user charges on a wider scale as a way to reduce
the magnitude of informal payments in the health system. This alternative was
published in a discussion paper along with many other reform options (Ministry
of Health, 2006).