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

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Health systems in transition Hungary
Act XXI of 1927 led to the establishment of the National Social Insurance
Institute, which administered the first nationwide SHI scheme to cover both
industrial workers and public employees, including their family members. It did
not cover agricultural workers, and although parliament accepted a resolution
to set up a separate scheme for this group, it was not implemented until 1945
(Tarsoly, 2000). By the 1930s, approximately one-third of the population was
insured.
Until the 1940s, health care was delivered mainly through the private sector
and in some state hospitals. Various SHI funds employed physicians and also
owned health care facilities. Rural areas were not well served, despite the
efforts of the Green Cross Service, which was staffed mainly by nurses.
Soon after it came to power in 1949, the communist regime nationalized
the economy, including the institutions responsible for funding and delivering
health care. The provision of health care services was declared to be a state
responsibility (1950/1), and the remaining tasks of the National Social Insurance
Institute were transferred to the National Council of the Trade Unions (Tarsoly,
2000). Private health enterprises, such as insurance companies and private
general practices, were dismantled and replaced by centralized state services.
Measures such as better sanitation and the compulsory immunization of
children soon led to substantial advances in public health and better control of
infectious disease (see section 1.4).
The Constitution of the Republic of Hungary, adopted in 1949, declared health
to be a fundamental right to be guaranteed by the state (1949/1). Throughout
the communist period, this was interpreted to mean that the state alone was
responsible for financing and delivering health services. The Ministry of Health
thus funded and delivered the whole spectrum of health services; in primary
care, a system of district physicians was established (1952/1). District physicians
were public employees and worked in single-handed practices. Private medical
practice was allowed only on a part-time basis (1972/2).
The improvements in population health status seen in the 1950s slowed in
the 1960s. Central planning allowed little flexibility to respond to changing
circumstances and weighted the health sector heavily towards achieving
quantitative targets. Moreover, resource allocation was subject to political
influence, which resulted in inequalities in service provision in terms of
geography and physician specialties. Although Act II of 1972 on Health
confirmed the link between citizenship and access to health services, and
promised comprehensive coverage free of charge, an increasing gap developed
between rhetoric and reality. By the 1970s, the system was suffering from