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

Health systems in transition Hungary 21
excess capacities, deteriorating service quality and a culture of widespread
informal payments. Between 1970 and 1989, life expectancy at birth declined
by almost one year for men and increased by only 1.8 years for women (see
section 1.4) (WHO Regional Office for Europe, 2010).
During the 1970s, the responsibility for providing outpatient care was shifted
mainly to hospitals; the aim of doing so was to facilitate the integration of
health services. Emphasis was placed on specialist care and district physicians
had a low status among medical doctors. Indeed, new entrants to the field
preferred to work in inpatient care, and patients themselves preferred to bypass
district physicians. As a result, the care provided by district physicians was not
comprehensive.
The need for radical health care reform became increasingly apparent in the
1980s (see section 1.4). The widening gap in health status between Hungary
and western European countries called for change, and the changing political
climate opened the way for reform. The first steps were taken in 1987, when
the Ministry of Social Affairs and Health 1 established a Reform Secretariat to
produce policy proposals. During this short period of reform in the last years
of the communist era, several important changes were made. Restrictions on
the private provision of health care were lifted (1988/2, 1989/5), and a Social
Insurance Fund, which pooled social insurance contributions separately from
the government budget, was created (1988/4) and made responsible for financing
the recurrent costs of health services (1989/6). The task of administering the
new fund was given to the National Social Insurance Administration, which
was already in place and had been responsible for collecting payroll-related
social insurance contributions and administering cash benefits – both of which
were elements of social insurance that had persisted during the communist era.
The head of the Reform Secretariat stayed in office under the new government
elected in 1990, allowing for a degree of continuity in health sector reform
during the period of profound economic and political transition that followed.
The first post-communist government was formed in March 1990 by a
coalition of the Hungarian Democratic Forum, the Independent Smallholders’
Party and the Christian Democratic People’s Party. This coalition successfully
established the contract model in the health care system between 1990 and 1994.
Act LXV of 1990 on Local Government created the provider side of the new
contract model (1990/3), devolving the ownership of primary care surgeries,
polyclinics and hospitals from central government to local governments along
with the responsibility, known as the “territorial supply obligation”, to ensure
1 As of 2010 called the State Secretariat for Healthcare within the Ministry of National Resources.