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

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Health systems in transition Hungary
the Hungarian State Railways, has its own comprehensive system of health
service delivery within which railway workers and their dependants are given
priority (1994/3). The number of providers and their capacities, however, were
significantly reduced in 2007 (2007/4). The Ministry of Defence has its own
inpatient and outpatient services, which are open to the general public, although
special rules give priority to its employees. According to the general principles
applied in health care financing, both ministries cover the capital costs of
services, whereas recurrent costs are financed through the HIF. The Ministry
of Public Administration and Justice provides health services to prisoners; this
is entirely separate from the main system of provision.
Finally, the Ministry of the Interior deals with issues for local governments,
which are the owners of most primary and secondary care facilities. Among
other duties, the Ministry administers the allocation of capital grants for health
care equipment and buildings to local governments (1992/9).
2.3.7 HIF and the NHIFA
The HIF is the most important financing agent for the recurrent costs of health
services, and finances certain cash benefits, such as sick pay. The HIF is
separate from the government budget in so far as any surplus it generates cannot
be used by the government for other purposes. The government is obliged to
cover any shortfall in the HIF (1997/8), and shortfalls in the HIF appear in the
government budget deficit. The HIF is divided into more than 30 sub-budgets
according to type of service (e.g. acute inpatient care, chronic inpatient care
and outpatient specialist care). Most of these sub-budgets are capped, and the
provider payment mechanisms help to ensure that the caps are, in fact, observed.
The NHIFA is a government office and thus under the direct control of
the state. It administers the HIF and is the sole payer in the Hungarian health
insurance system. It has no discretion over revenue collection or budget setting,
however, and has only very limited discretion over purchasing decisions (see
sections 2.3.2 and 3.4.3). The NHIFA has territorial units and subunits at the
regional and county levels, respectively. These units manage administrative
work and other tasks delegated by the NHIFA central office, but have no
autonomy in contracting and paying local health providers. Moreover, the
budget of the NHIFA has remained centralized since its inception.