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

Health systems in transition Hungary 197
Large segments of the Roma population in Hungary live under
disadvantageous conditions, typically in underdeveloped regions of the country.
This is reflected in their health status, which is worse than that of the non-Roma
population, with life expectancy being 10 years shorter. The frequency of
certain diseases is also considerably higher among the adult Roma population
(over the age of 19) than in the general population (Babusik, 2004a). Vokó et al.
(2009) found, however, that socioeconomic status is a strong determinant of
health of people living in Roma settlements in Hungary and thus ethnicity per
se may not be the only explanation.
7.5 Health system efficiency
Payment reforms are one of the health care reform success stories in Hungary.
First, the output-based payment methods substantially improved the technical
(production) efficiency of the system and potentially paved the way for a direct
increase in allocative efficiency by enabling the allocation of more financial
resources to previously underfunded high-need regions. Second, the reforms
were implemented over a long period of time, extending over election cycles,
that is, there was a political (albeit unspoken) consensus making the reforms
feasible. Third, as a by-product, the information system built around these
payment reforms has made the system more transparent and accountable (e.g.
quality indicators could be constructed from the reported performance data and
compared across providers). Finally, Hungary was one of the first countries in
Europe to introduce a DRG-based system for the payment of acute inpatient
care, which is now the dominant payment technique all over Europe. As will be
discussed in the following section, however, allocative efficiency in the health
care system is still problematic, and these problems cannot be addressed by
adjusting the payment system alone.
7.5.1 Allocative efficiency
As far as resource allocation among the various sectors of the economy is
concerned, current overall public spending on health care in Hungary is low,
both in comparison with neighbouring countries at a similar level of economic
development and with historical spending. According to a study carried out by
the Hungarian National Bank in 2007, net public expenditure on health as a
share of GDP was 2.1 percentage points less than the average of the other three
Visegrád countries (P. Kiss & Szemere, 2009), while Hungary was spending