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

Health systems in transition Hungary 185
of health services to the HISA, which thus played an important role in patient
protection until it was abolished in August 2010. Its functions were distributed
between the State Secretariat for Healthcare, the NPHMOS and the NHIFA.
Equal access for equal need
Equity is also a defining objective in Act CLIV of 1997, with roots in the
preceding, Semashko-style health care system – where access to care was not
to depend on one’s ability to pay – and has remained unaltered throughout
successive government reforms. Act LXXXIII of 1997 on the Services of
Statutory Health Insurance and related lower-level regulations further clarify
the practical implementation of the equity objective (see also annexed list of
laws and regulations in the Annex (section 9.1). as well as sections 3.3.1 and
3.4). Within the legal framework of the statutory health insurance system, each
patient is supposed to receive the same standard of care as far as clinical quality
is concerned (see also section 3.3.1). Legal coverage, however, does not say
much about effective coverage, that is, actual access to services of the publicly
funded benefit package. The introduction of the DRG system (HDGs) in 1993
made visible the uneven development of specialties and the geographical
disparities in access to care. The implementation of the new payment system
rectified some distortions of resource allocation, as did the two waves of
downsizing of the excess capacity in acute inpatient care (see also section 4.1.2).
The introduction of the CCS in 1998 made the significance of the problem of
unmet need more obvious (see also section 7.5.2). Another obstacle to achieving
this objective is the long-standing, deep-rooted practice of informal payments,
which endorse inequity in more ways than one (see sections 7.2.1, 7.2.2 and
3.4.3). Since autumn 2008, access to care has been further compromised by
the consequences of the global financing crisis and the serious budget cuts in
health care, coupled with a rapidly accelerating health workforce migration
(see also section 7.3.2).
Evidence-based provision of services
Act CLIV of 1997 on Health declares that health care should be provided
according to evidence-based guidelines, protocols or, in the absence of these,
published and widely accepted professional requirements (1997/20). Moreover,
Act LXXXIII of 1997 on the Services of Compulsory Health Insurance explicitly
excludes from the benefit package health services whose effectiveness has not
been established on the basis of evidence. As a general rule, the insured are
entitled to services according to guidelines and protocols issued by the State
Secretariat for Healthcare. However, the Act does allow medical doctors to