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

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Health systems in transition Hungary
An important disadvantage of indicators such as catastrophic and
impoverishing health expenditure is that they cannot capture the whole impact
OOP spending has on the poor. For example, low-income households might not
experience catastrophic health expenditure during a particular study period
because they delay or forgo health care precisely due to the deterrent effect of
high OOP payments.
Even though user charges introduced in February 2007 (and eliminated in
April 2008) involved the seemingly negligible amount of HUF 300 (or about
€1.20) per outpatient visit and per hospital day, their deterrent effect on the
poor was indeed unexpectedly large. According to a survey carried out in April
2007, 15% of respondents said that had not visited a physician because of the
co-payments. Among people who had completed only their primary education,
this figure was as high as 25%, whereas it was 10% among those with a higher
degree of educational attainment. Similar differences were observed among
different income groups (GfK Hungaria, 2007).
These user charges were also expected to tackle the issue of informal
payments (see section 3.4). However, according to another survey, 30%
of participating physicians reported that the introduction of co-payments
diminished informal payments by an average of 14%, whereas 47% did not
notice any change and 1% observed an increase. Only 6.6% of patients said that
they had not made any informal payments, or paid less since the introduction
of user charges (Szinapszis Kft, 2007). A different study estimated a decrease
of 25% in informal payments overall (Medián, 2008). Finally, expenditure on
informal payments and the newly introduced co-payments combined increased
by over 20% in nominal terms in 2007. This suggests that the overall burden
on patients increased, compromising financial protection, equity in financing
and access to care.
7.2.2 Equity in financing
When evaluating equity in financing in the Hungarian health care system, it is
essential to distinguish between theory and practice. By design, the sources of
health care financing in Hungary are predominantly public and thus theoretically
closer to the middle of the regressivity–progressivity spectrum. Although no
longer subject to a ceiling, HIF contributions remain mildly regressive because
(a) they are levied only on gross wages (and not on capital income) and (b) there
is a minimum contribution base. The hypothecated health care tax, however,
is more difficult to place on the regressivity–progressivity spectrum. Whereas
the lump-sum component, in place until January 2010, was clearly regressive,