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

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Health systems in transition Hungary
Stewardship of the single-payer health insurance system in Hungary has
become increasingly blurred. The initial self-regulation arrangement was
quickly eliminated and the governance structure of the HIF has gone through a
series of changes that have increased direct central control, reduced stakeholder
participation and exposed the system to political pressures, thus leading to less
transparent and more unpredictable funding arrangements. Although largescale
and strategic reform initiatives addressing the stewardship function of
the system have failed in most cases, there have been several useful technical
improvements, especially in the area of health financing. Examples include
the successful introduction of HTAs and the creation of incentives to increase
generic competition.
Health care reforms have also been unable to address increasing problems
related to allocative efficiency, even though technical efficiency has improved
over time. Informal payments have survived 20 years of health sector reform,
and there is a human resource crisis emerging due to the ageing of health
care professionals, staff shortages and increasing migration, especially among
physicians.
Ensuring appropriate incentives to increase efficiency in patient pathways
has been addressed by successive governments. The CCS (introduced as a pilot
programme in 1999) had many innovative features and provided a countryspecific
response to the problem of allocative efficiency, but was eliminated in
2008 without a full scientific evaluation.
In the years since 2004, cost-containment has remained the dominant health
policy objective. Public expenditure on health has declined substantially, falling
to 5.1% of GDP in 2009. This has had a direct impact on the growing human
resource crisis. Moreover, during the periods of cost-containment, efficiency
gains resulting from cost-containment measures have been extracted to help
reduce state debt rather than being reinvested in the health sector. A key problem
is the continuing lack of an overarching, evidence-based strategy for mobilizing
resources for health. Without this, the health system remains vulnerable to
broader economic policy objectives. A diversification of revenue sources for
health seems to be developing, along with a recent strategic policy on taxation,
but it remains to be seen whether the mix of insurance contributions and budget
transfers from general taxation will provide a stable funding arrangement.
Two further challenges the government faces in achieving a more efficient
and more equitable service delivery system is to reorganize existing capacities
based on health needs assessment and to tackle informal payments. There is
some evidence that the introduction of user fees reduced the magnitude of