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

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xxiv Health systems in transition Hungary reimbursement varies. Products submitted for inclusion in the reimbursement list are evaluated according to a variety of criteria, including health policy considerations and cost-effectiveness. The price of medicinal products is determined by the market. Medical rehabilitation is underfunded and short-staffed, and access to services is subject to substantial regional disparities. Long-term care is provided by both the health and the social sectors. Local governments are responsible for providing social care, which takes the form of cash and in-kind benefits provided mostly to impoverished individuals and those with disabilities. Palliative care is still in its infancy. The importance of informal carers, who in some cases are eligible for financial assistance, has been recognized. Mental health care is integrated into the main health and social care system, both organizationally and in terms of financing. Chronic outpatient care is provided by dispensaries, while inpatient care can also take place on a daytime hospital basis. Most dental services are available free of charge and are divided into primary care, specialist or out-of-hours services. Dental care is an area of health care in which private provision is predominant. Hungary is also a target country for over 40% of all dental tourism in Europe. Recent health care reforms A variety of reforms have been implemented and attempted since the previous HiT profile on Hungary was published in 2004, with varying success. The most important of these aimed to reshape the stewardship and organization of the health care system in several ways, such as by strengthening the care coordination system; introducing new ways to regulate the capacities of providers; supporting the corporatization and outsourcing of public providers; encouraging intersectoral cooperation to implement the National Public Health Programme (NPHP); introducing managed competition to the health insurance system by replacing the NHIFA/HIF with multiple health insurers under partial private ownership; and setting up the Health Insurance Supervisory Authority (HISA). Despite extensive government efforts to push forward these measures most of the reforms did not meet their stated objectives. Since 2004, cost-containment has remained the dominant health policy objective, and public expenditure on health has declined substantially, falling to 5.2% of GDP in 2009. This, in turn, has had a direct impact on the growing human resource crisis in the health system. Regarding revenue collection, successive governments since 2004 have failed to formulate an overall policy
Health systems in transition Hungary xxv framework that might mobilize a stable and predictable flow of resources for the health system. This is arguably the most serious shortcoming of the Hungarian health system today. The funding of the health system is strongly influenced by policy goals not directly related to health, such as labour and broader economic policy objectives. Looking back at the recent health reforms, transparent, evidence-based policy-making often played a limited role in the area of health policy in several important respects. Major reforms have usually not been supported by detailed policy instruments, such as discussion papers, strategies, action plans or impact assessments. At the same time, mechanisms allowing stakeholders to take part in the decision-making process in a timely and transparent manner have been lacking. Assessment of the health system In Hungary the objectives of the health system are either set explicitly in various laws, regulations and policy documents, or implicitly by the actions taken by the government. They mostly revolve around the protection and promotion of patient rights, the assurance of equal access to services for equal need, the provision of evidence-based, effective services and the achievement of system efficiency. Very few households experienced catastrophic or impoverishing health expenditure between 2003 and 2007. At the same time, avoidance and evasion have been a persistent problem, especially in the health care system. Combined, unpaid health and pension insurance contributions amounted to almost 1% of GDP in 2008. A study conducted in 2002 found that the taxes and social insurance contributions used to financed the health care system were, on the whole, mildly regressive. Residents of Hungary are generally dissatisfied with their health system, and Hungary ranked 26th among the 27 EU Member States in 2009 in terms of population satisfaction. Large variations exist in service delivery, both geographically and by specialization, and equity of access is far from being realized. This is also mirrored in differing health outcomes for different population groups. Overall, life expectancy at birth is relatively low and avoidable mortality rates are high.
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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 and 22: Executive summary Introduction Hung
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3. Financing 3.1 Health expenditure
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8. Conclusions Since the mid-1990s,
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The Health Systems in Transition pr
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The European Observatory on Health
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