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

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186 Health systems in transition Hungary deviate from their provisions in order to ensure the best medical outcome for individual patients. Several measures have been implemented endorsing quality control and improvement in Hungary (see section 7.4.2). Efficient provision of services Several measures have been taken over time to improve service provision and increase the efficiency of the system. Although the overall public expenditure on health seems to have been contained successfully, this does not necessarily mean that resource allocation has been efficient within the health sector (see section 7.5.1). Improving technical (production) efficiency has been strived for over almost two decades: introducing HDGs in 1993 was seen as a means to increase productivity and efficiency and promote cost-consciousness among hospital management. Several mechanisms to prevent the abuse of the system and ensure quality of care for patients are also in place and technical efficiency seems to have increased over the past few years (see section 7.5.2). Cost-containment Even though it cannot be classified as an objective of the health system per se, one of the most important policy goals over the past 20 years has been the containment of health expenditures. The actions of successive governments and resulting health care budget cuts leave no doubt that these have been under tight central control: between 1990 and 2000, health expenditures dropped by nearly 30% in real terms (see also section 3.1). Given that the government is obliged to cover the deficit of the HIF, rising health expenditures have increasingly been seen as a potential threat to fiscal balance (see section 3.3.2). While the overall cost-containment policy was successfully implemented, no explicit priorities were set for the use of resources within this reduced budget. Further, not enough attention has been paid to the potential negative impact of these measures on population health status and the quality, accessibility and long-term sustainability of health care. 7.2 Financial protection and equity in financing 7.2.1 Financial protection The magnitude of private expenditure on health in Hungary – most of which is attributable to OOP spending – is still unclear, not least because of divergent estimates on the extent of informal payments (see section 3.4.3 as well as section 3.1). OECD data indicate that after an increase from about 11% in 1991 to a peak of 31% in 2001, private expenditure as a share of total expenditure on
0.80% 0.70% 0.60% 0.50% 0.40% 0.30% 0.20% 0.10% 0.00% Health systems in transition Hungary 187 health has hovered between 27% and 30%. The figure for 2008 was 29%, which puts Hungary in second place within the EU – just below the Slovak Republic (30%), slightly above Poland (28%), and considerably higher than the Czech Republic (18%) (OECD, 2010). A breakdown of OOP spending in Hungary can be found in section 3.4. Despite these numbers, according to a recent WHO study on financial protection, less than 1% of Hungarian households experienced catastrophic 2 (0.31–0.73%) or impoverishing (0.003–0.24%) health expenditure between 2003 and 2007, and the poverty gap was small. This means that some 11 000–28 000 households in Hungary experienced catastrophic expenditure, and 3400–9000 households experienced impoverishing health expenditure during this period, with a poverty gap of HUF 1–2 billion (€3.95–7.9 million) (Gaál, 2009). Looking at these indicators over time shows that between 2003 and 2006, there was a decrease in the percentage of catastrophic and impoverishing health expenditure, followed by a notable increase in 2007 (Fig. 7.1). This increase coincides temporally with the introduction of several health policy measures, including user fees in ambulatory and inpatient care (see section 3.4) and an increase in and restructuring of cost-sharing for pharmaceuticals (2006/8). Fig. 7.1 Percentage of households in Hungary experiencing catastrophic or impoverishing health expenditure, 2003–2007 2003 Source: Gaál, 2009. 2004 2005 2 In this study, household expenditure on health was considered catastrophic when it exceeded 40% of the household’s disposable income. 2006 2007 Catastrophic health payments Impoverishing medical expenditures
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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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xiv Health systems in transition Hu
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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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4. Physical and human resources 4.1
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5.0 4.5 4.0 3.5 3.0 2.5 2.0 Health
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5. Provision of services Health car
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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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