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

Health systems in transition Hungary 23
the right to choose their own family doctor (1992/3), and capitation payment
and contracting of family doctor services were introduced (1992/4). Family
doctors were encouraged to enter into private practice, contracting with their
local government for the provision of primary care services, but working in
surgeries and with equipment still owned by the local government. This kind of
arrangement is often described as “functional privatization” and is the dominant
form of provision in the primary care sector in Hungary (see section 5.3).
New payment mechanisms for all other health care services were initiated
during this period. The introduction of output-based payment methods, such
as fee-for-service payment in outpatient specialist care, Homogeneous Disease
Groups (HDGs, the Hungarian version of DRGs) and per diem payments in
inpatient care, was coupled with the capping of the various sub-budgets of
the HIF (see sections 2.3.8, 3.4.3 and 3.7) (1992/8, 1993/5, 1993/6). From a
cost-containment perspective, these measures have remained an effective tool
under the oversight of successive governments (see section 7.5).
In late 1993, the National Assembly created the legal framework for
establishing voluntary non-profit health insurance (1993/10). Voluntary health
insurance funds in Hungary provide complementary and supplementary
coverage for health and preventive services. These voluntary schemes cannot
operate, however, as substitutive insurance (see sections 2.3.11 and 3.5 for more
details). In 1994 the Hungarian Medical Chamber and the Hungarian Chamber
of Pharmacists began to operate on a self-regulatory basis, with compulsory
membership for practising physicians and pharmacists (1994/2, 1994/5).
National drug companies and the wholesale and retail industries were mostly
privatized, and the pharmaceutical market liberalized.
The elections in 1994, which brought a coalition of the Hungarian Socialist
Party and the Alliance of Free Democrats to power, were followed by a
period of cost-containment, including cuts in the overall budget for health
care and a shifting of costs to patients. The latter development was somewhat
counterbalanced by tax rebates for the purchase of voluntary non-profit health
insurance (1995/14). In addition, the responsibility for occupational health
services was shifted to employers (1995/8).
The government also decided to address the size of the hospital sector,
assigning the Minister of Welfare to determine the capacities the NHIFA had
to contract for under the territorial supply obligation (1995/9). As a result, about
9000 beds were ultimately removed from the system. In 1996, however, reliance
on the direct intervention of the Minister of Welfare was replaced by a needs-