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

Health systems in transition Hungary xxvii
Hungary has achieved a successful transition from an overly centralized,
integrated Semashko-style health care system to a purchaser–provider split
model with new payment methods that have created incentives to improve
technical efficiency. Hungary’s unique patient identification system, which
provides patient-level information on pharmaceutical consumption and the use
of specialist inpatient and outpatient services represents a rich, integrated data
set whose potential has yet to be fully realized in academic research and health
policy decision-making.
Stewardship of the single-payer health insurance system has become
increasingly blurred. 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 pressure, thus leading to
less transparent and 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 health technology assessment (HTA) 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. 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 country-specific response to the problem of allocative efficiency, but was
eliminated in 2008 without a full scientific evaluation.
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 are to reorganize existing capacities
based on health needs assessment and to tackle informal payments. At the
same time, several existing initiatives could provide substantial improvements
if they are expanded upon and refined. New information systems have made
the health care system more transparent and accountable. Although attempts