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

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xx Health systems in transition Hungary primarily through compulsory, non-risk-related contributions made by eligible individuals or by the government (from the state budget). Entitlement to benefits is based on these contributions. The contributions themselves are pooled in the Health Insurance Fund (HIF), which is administered by the National Health Insurance Fund Administration (NHIFA). The latter is the sole payer in the system. It is under the direct control of the state, has no discretion over revenue collection or budget setting, and has only limited discretion over purchasing decisions. The central government has almost exclusive power to formulate strategic direction and to issue and enforce regulations. It exercises strict control over revenue collection, as well as in determining the benefits package, setting uniform requirements for provider reports, setting budgets, allocating financial resources, and engaging in contracting and payment. Local governments own most hospitals and other health care facilities and are responsible for the capital cost of health services and for ensuring the provision of care. Private entrepreneurs and businesses play a central role in primary and pharmaceutical care and an increasing one in specialist care. The use of private capital in the provision of inpatient care, however, remains controversial. To date, health policy-makers have had little success in influencing the organizational framework of other areas of public policy in order to create the appropriate organizational framework for setting intersectoral health goals. Moreover, although some efforts have been made to improve access to health services among marginalized sections of society, planned interventions to deal with health inequities within the wider framework of social determinants of health are still lacking. Financing The issue of health system financing has dominated the health care agenda of consecutive governments since the changeover from the communist regime. The first wave of reforms (1989–1993) transformed the system from one financed primarily through taxes to one based on compulsory health insurance. In 2009 Hungary spent 7.4% of its GDP on health, with public expenditure accounting for 69.7% of total health spending. Health spending has been unstable over the years, with several waves of increases followed by longer periods of cost-containment and budget cuts. The share of total health expenditure
Health systems in transition Hungary xxi attributable to private sources has been increasing, most of it accounted for by OOP expenses. Voluntary health insurance, on the other hand, amounted to only 7.4% of private and 2.7% of total health expenditure in 2009. Public expenditure on health is financed mainly through a combination of contributions and general tax revenue transfers to the health insurance scheme. There has been increasing reliance on the latter in recent years. Participation in the health insurance scheme is compulsory for all citizens living in Hungary, and opting out is not permitted. Based on the current legal framework, coverage should theoretically be 100%, but the health insurance status of approximately 4% of the population is unclear. The benefits package is comprehensive but not exhaustive. Both a positive and a negative list are currently in place. A considerable and relatively stable share of OOP expenses is attributable to informal payments, which are a well-known phenomenon within the Hungarian health care system. Voluntary health insurance does not play a significant role at present and has only supplementary and complementary functions. Other sources of finance also contribute to total health expenditure, such as EU capital grants, which are invested mostly in human resource and health care infrastructure development. The collection and pooling functions in the Hungarian health insurance scheme are separate, but there is no complicated mechanism to distribute resources from the collecting agency (the Tax Office) to the main pooling agency (the NHIFA), which is also the sole payer in the system. The NHIFA does not have much discretion over active contracting, however, because purchasing is based on a contract model and the terms of contracts are determined by the National Assembly. The provider payment system has become output-based, and payment mechanisms are geared to the type of service provided rather than the type of institution responsible for provision. Family doctor services are paid through capitation, outpatient specialist care through a fee-for-service point system, acute inpatient services through a payment system based on diagnosis-related groups (DRGs) and chronic care through per diem rates. Special rules apply to certain services, such as emergency patient transfers. Physicians are either salaried employees or private entrepreneurs contracted by the NHIFA, whereas other health professionals are mostly paid by salary.
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Page 3 and 4: Health Systems in Transition Péter
Page 5 and 6: Contents Preface
Page 7 and 8: Preface The Health Systems in Trans
Page 9 and 10: Acknowledgements The Health System
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Page 19 and 20: Abstract Hungary has achieved a suc
Page 21: Executive summary Introduction Hung
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Page 31 and 32: 1. Introduction 1.1 Geography and s
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Page 48 and 49: 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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6. Principal health reforms 6.1 Ana
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8. Conclusions Since the mid-1990s,
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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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