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198 Health systems in transition Hungary more on general public services, economic activities and especially social protection. In other areas, such as education and defence, public spending was close to the averages of Slovakia, Czech Republic and Poland. This study made considerable adjustments to absolute expenditure numbers in order to render them as comparable as possible. Therefore figures may differ from other data sources used in this review (such as the OECD Health Data) where such adjustments are not implemented. Moreover, HIF expenditure on curative and preventive services was almost 25% (225 billion HUF, or 0.9% of GDP) less in real terms in 2009 than in 1990, although this comparison does not account for technological developments in the past 20 years (authors’ calculations based on HCSO, 2010f). Accordingly, OECD data shows a substantial drop in public expenditure on health, which fell from 7.1% of GDP in 1994 to 5.2% in 2009, moving in the opposite direction to the trend in many other European countries (see section 3.1). All of this suggests that the policies of successive governments to contain public expenditure on health have been implemented effectively. However, cost-containment in itself does not ensure efficient resource allocation within the health sector. It is difficult to assess inefficiency resulting from the misallocation of resources among various levels of care and service areas from aggregate spending data, but the structure of HIF expenditure could be used as a crude proxy. The allocation of financial resources has not changed significantly since 1994: there was a small drop in the share of inpatient care and a slight increase in the share of outpatient specialist care around the 2007 structural reforms, but these changes have remained within a range of five percentage points, without showing any clear or sustained trend that might be interpreted as a sign of the purposeful reallocation of resources among levels of care (see also section 3.1 and Table 3.2). In contrast, spending in the pharmaceutical sub-budget of the HIF has shown a general upward trend since 1993. It has peaked twice, in 1998 and 2006, spurring government efforts to contain pharmaceutical expenditure. The strict cost-containment measures introduced in 2007 have yielded concrete and measurable results in decreasing the overspending of the pharmaceutical sub-budget of the HIF, although this was mainly achieved by increasing patient cost-sharing (2006/8) (see also section 3.3.3).
Health systems in transition Hungary 199 7.5.2 Technical (production) efficiency During the communist era, hospitals received line-item budgets based on historical spending, which has long been associated with inefficiency and low-quality services. In Hungary, however, the influence of politics on the budget negotiation process also led to large geographical disparities and an uneven development of the various specialties. Introducing DRGs (HDGs) for hospital payment was seen as a way to address these problems by providing incentives to increase productivity and efficiency, promote cost-consciousness among hospital management and somewhat reduce regional differences in service provision (see subsection Specialized ambulatory/inpatient care in section 3.7.1). Initially, however, the extent of geographical disparities already in place was mirrored in the HDG production cost (Table 7.3). Table 7.3 HDG base rate (per standard case), 1993 HUF Deviation from average (mean = 100%) Medical universities average* 30 900 100.0% minimum 26 320 85.2% maximum 52 680 170.5% County hospitals average 29 210 100.0% minimum 20 860 71.4% maximum 38 990 133.5% County hospitals – East Hungary average 26 450 90.6% County hospitals – West Hungary average 29 980 102.6% Municipal hospitals average 25 200 100.0% minimum 17 000 67.5% maximum 40 380 160.2% Municipal hospitals – East Hungary average 23 820 94.5% Municipal hospitals – West Hungary average 25 980 103.1% Source: Gyogyinfok data, personal communication. Difference between min-max & E-W 200.2% 186.9% 113.3% 237.5% 109.1% To analyse the impact of the HDG payment system on technical efficiency, it is helpful to look at a range of performance indicators from 1990 to 2008 (Table 7.4). However, the two most readily available indicators of technical efficiency – bed occupancy rate and average length of stay – are not very useful in this case. 6 6 Bed occupancy rate depends on the number of beds, which alone is only loosely correlated with actual costs of care. The same is true for average length of stay: the association between the number of hospital days and cost of care is not linear, with the bulk of the costs being concentrated in the first couple of days of inpatient care (Carey, 2000).
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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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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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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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