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

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Health systems in transition Hungary
based formula to determine health care capacities. This formula called for
cuts in hospital beds in most counties, but left the details to county consensus
committees (1996/4).
Another target of the cost-containment measures was the self-government
of the HIF. Since the extensive rights of the HIF on budgetary decisions made
it difficult to cut the HIF budget, these rights were curtailed in 1996 (1996/3,
1996/11). In addition, the government weakened the self-governance of both the
HIF and PIF through restructuring in 1997 (1997/5).
The government’s revenue-side strategy consisted of three components:
widening the HIF contribution base, decreasing the employer HIF contribution
rate and introducing a lump-sum tax, known as the hypothecated health care
tax (1996/9, 1997/8). One aim of these measures was to increase HIF revenue
by combating the evasion of HIF contributions (see section 3.3.2).
A proposal was prepared in 1998, which envisaged a reform of health system
financing involving the introduction of competing health insurance funds, but
the government had no time to debate or put this idea into practice as the 1998
elections brought the opposition into power.
In May 1998, the Fidesz-Hungarian Civic Party formed a coalition
government with the Hungarian Democratic Forum and the Independent
Smallholders’ Party. One of the government’s first measures was to abolish
the self-government of the HIF and PIF (1998/15). Control of the NHIFA was
transferred to the Prime Minister’s Office (1998/16) and subsequently to the
Ministry of Finance (1999/5). Instead of reforming the financing side, the policy
focus was shifted to the health care delivery system, but against the background
of the persistent efforts to contain overall health expenditure.
During its time in power, the government targeted both the revenue and
expenditure sides of the HIF. To overcome the problem of contribution evasion,
the government added a proportional component to the hypothecated health care
tax (1998/19). At the same time, it decreased the HIF contribution substantially
(1998/20). The government also shifted the responsibility for collecting HIF
contributions to the Tax Office (1998/26) (see sections 3.2 and 3.3.2).
After rejecting renewed proposals to introduce health insurance competition,
the Ministry of Health 3 implemented the government’s first delivery-side reform
measures in early 2000, introducing a complex quota system for family doctor
practices based on practice permits (known in Hungarian as the “practice right”,
3 As of 2010 called the State Secretariat for Healthcare within the Ministry of National Resources.