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

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Health systems in transition Hungary
the supply of health care services to the local population. As part of the reform
of public health and the modernization of health system administration, the
NPHMOS was established as a state agency in 1991 (1991/1). After a debate on
whether to move towards a single-insurance model or a system with multiple,
competing health insurers, a single-insurance model was chosen, but the option
of introducing competition among multiple insurance plans in the future was
left open (1991/3).
From 1990 until 1992, health insurance and pension insurance in Hungary
were financed through the Social Insurance Fund. In 1992, however, the
government divided the Social Insurance Fund into two entities: the HIF and
the Pension Insurance Fund (PIF) (1992/2). The administration of these funds
was reformed in mid-1993, when the National Social Insurance Administration
was divided into the NHIFA and the National Pension Insurance Fund
Administration (NPIFA) (1993/7).
Act LXXXIV of 1991 defined quasi-public bodies for supervising the HIF
and PIF, the so-called self-governments, which consisted of representatives of
employers and employees (1991/5). The Health Insurance Self-Government and
its pension counterpart began to operate in 1993, after the general population (or,
more precisely, the insured population) elected employee representatives from
candidates put forward by various trade unions, while employer representatives
were delegated by employer associations (1993/3). Until the self-governments
were formed, supervisory rights were exercised first by the Minister of
Welfare (1990/1), as the State Minister for Health was then known, and later
by a ten-member parliamentary committee (1991/5). The self-governments
were granted extensive rights over budgetary decisions and given a veto on
government decisions related to social insurance.
During the legislative period 1990–1994, a range of policies were gradually
introduced to strengthen primary care. In 1991 the National Institute of Family
Medicine was established to coordinate efforts at raising professional standards
in this sector (1991/6). In 1992, the system of district physicians was reformed:
the administration of primary health care was removed from the remit of
hospitals, “district physician services” were renamed “family doctor services”,
and family medicine was introduced as a new and compulsory specialization to
be attained by all physicians working in primary care (replacing the specialty
in general practice that had been introduced in 1976) (1992/3). The separation
of adult and child care in large municipalities, which had been a characteristic
of the district physician system, was maintained 2 . People were also given
2 Throughout this review the term “family doctor” includes family physicians and family paediatricians.