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

Health systems in transition Hungary 35
to private practice family doctors under the functional privatization scheme (for
more details see section 2.8.2). Similar arrangements have grown increasingly
common in secondary care since the late 1990s.
The same Act transferred the ownership of most primary care facilities,
polyclinics and hospitals from the national government to the local governments
(1990/3). As a result, local governments have become the main health care
providers in the Hungarian health care system. Municipalities usually own
primary care facilities and, in the case of larger municipalities, may own and
run outpatient clinics and municipal hospitals. County governments usually
own large county hospitals, which provide secondary and tertiary care.
As the owners of health care facilities, local governments are responsible
for funding the capital costs of the health services they provide. Since these
costs are usually higher than the revenue of local governments, the central
government provides conditional and matching capital grants through the
system of earmarked and target subsidies (1992/9). It has often been argued,
however, that even local and central funds together are not sufficient to cover
capital costs over the long term, thus threatening the sustainability of the system.
In 2004 the National Assembly formed regional health councils to support
the creation of regional health policies and development projects; to facilitate
cooperation among the stakeholders, especially regarding negotiations on the
distribution of regional capacities within secondary and tertiary care; and to
conduct evaluations of patient satisfaction and access to care and draw up
appropriate recommendations. The council members consist of representatives
of the counties, churches, medical universities, health care providers, the State
Secretariat for Healthcare, the NHIFA and patient associations.
2.3.10 Professional organizations, associations and unions
The work of voluntary associations and trade unions was kept under tight
control until the second half of the 1980s. In the late 1980s, when the health
sector trade union of the communist regime lost its monopoly, several new
unions were established, the largest being the Health Workers’ Democratic
Union. A notable feature since the mid-1990s has been the rapid growth in the
number of other voluntary organizations, some of which are not just simple
interest groups, but have been delegated regulatory functions that were formerly
under direct governmental control.