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

Health systems in transition Hungary 211
data, but rather of a comprehensive conceptual and legal framework for dealing
with the various obstacles entailed in merging routine databases that are
maintained by different actors in the health sector. This is largely attributable
to a lack of political commitment to health policy objectives other than fiscal
sustainability and a prolonged narrow focus on short-term cost-containment.
Thus, the most sophisticated transparency and accountability framework
in the Hungarian health system today is that related to costs. Publicly funded
providers are obliged to observe predefined budgets at various levels of the
health system and to follow the rules of the different health care financing
mechanisms. Sanctions range from fines and the withdrawal of funds or
operational licences to civil and criminal penalties (including financial
compensation and banning from public affairs), and have become increasingly
strict.
The framework for setting targets and for monitoring and evaluating
equity and quality in the system is less well developed. Attempts to ensure
transparency and accountability have been based on the secondary analysis
of existing routine databases, mainly the health care utilization database of
the NHIFA. Currently, responsibility for ensuring equity is not clearly defined
and is limited to waiting lists, such as those for transplantation, which have
been established at the national level or at the level of providers, in accordance
with the legal framework defined by the legislation on health and health
insurance in 1997 (see section 7.1 and the annexed list of laws and regulations
in section 9.1). At present, quality of care in Hungary is controlled mostly
indirectly, by means of minimum standards for facilities, equipment and human
resources required from providers of primary, outpatient specialist and inpatient
care. The NPHMOS is responsible for registering and licensing providers,
including individual physicians and hospitals. Hospitals that are legally obliged
to supply services in a given geographical area as part of the territorial supply
obligation are required to maintain a quality-control system and to establish a
supervisory council.
Although a range of initiatives have been developed to measure and track the
quality of care using quality indicators, these have not yet been implemented
systematically. Some health care providers have established their own internal
and external quality-control mechanisms based on models developed by the
International Organization for Standardization and the European Foundation
for Quality Management (see also section 7.4.2). A professional supervisory
system maintained by the National Centre for Healthcare Audit and Inspection
was created in 2005 based on the principles and practice of clinical audit.