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

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60 Health systems in transition Hungary Office for Europe, 2011). The economic stabilization policies implemented by the government in 1995 and 1996 were continued by the next administration, at least with regard to the health sector. Table 3.1 Trends in health expenditure in Hungary, 1995–2009 1995 2000 2005 2008 2009 Total expenditure on health (billions of HUF) 420 939 1831 1933 1940 Total expenditure on health (billions of US$ at PPP) a 6.8 8.7 14.2 14.4 n/a Total expenditure on health, US$ per capita at PPP, WHO estimates 658 853 1411 1495.5 1510.7 Total expenditure on health as % of GDP 7.3 7.0 8.3 7.2 7.4 Public expenditure on health as % of total expenditure on health 84.0 70.7 72.3 71.0 69.7 Private expenditure on health as % of total expenditure on health 16.0 29.3 27.7 29.0 30.3 Public expenditure on health as % of total government spending a 11.3 10.6 12.0 10.5 n/a Public expenditure on health as % of GDP 6.1 5.0 6.0 5.1 5.2 Private expenditure on health as % of GDP 1.2 2.1 2.3 2.1 2.3 Out-of-pocket payments as % of total expenditure on health 16.0 26.3 23.8 23.8 23.7 Out-of-pocket payments as % of private expenditure on health 100.0 89.8 85.9 82.1 78.2 Out-of-pocket payments as % of GDP 1.2 1.8 2.0 1.7 1.8 Spending through voluntary health insurance as % of total expenditure on health 0.0 0.2 1.1 2.2 2.7 Spending through voluntary health insurance as % of private expenditure on health 0.0 0.6 4.1 7.4 7.4 Spending through voluntary health insurance as % of total expenditure on health – 0.2 1.1 2.1 2.7 Spending through voluntary health insurance as % of private expenditure on health – 0.6 4.1 7.4 7.4 Sources: OECD (2011); a WHO Regional Office for Europe. Due to a large increase in public sector wages in 2002, public expenditure on health increased as well, peaking for the second time since 1994 at around 6.0% of GDP between 2003 and 2005 (WHO Regional Office for Europe, 2011). However, austerity measures aiming to meet the financial criteria for introducing the euro in Hungary substantially reduced public spending on health, as did a spate of additional cost-containment measures taken in the wake of the global economic crisis, which hit Hungary with full force in the autumn of 2008. In late 2010, the macroeconomic climate was still unfavourable, and the government had little choice but to observe the deficit target set by the EU and the IMF, both of which appear to have taken a hard line as a result of the financial crisis in several EU countries. Substantial increases in public spending on health should therefore not be expected in the near future, despite government declarations to the contrary (Government of the Republic of Hungary, 2010a).
11 10 9 8 7 6 5 4 Health systems in transition Hungary 61 The most notable feature of health spending in Hungary is its instability, with several waves of short spending increases followed by longer periods of cost-containment and budget cuts. Successive Hungarian governments since 1990 have implemented effective cost-containment policies, reducing public expenditure on health from 6.1% of GDP in 1995 to 5.2% in 2009 (Table 3.1). Comparative data reveal that decreases in total health expenditure as deep as those seen in Hungary between 1994 and 1998, and again between 2005 and 2008, did not occur in any of the Visegrád Four countries after the mid-1990s (Fig. 3.1). Fig. 3.1 Trends in health expenditure as a share (%) of GDP in Hungary and selected countries, 1994–2008 (or latest available year) 1995 1996 1997 1998 1999 2000 Source: WHO Regional Office for Europe, 2010. 2001 2002 2003 EU members before May 2004 Czech Republic Poland EU members since 2004 or 2007 In fact, Hungary (along with the Czech Republic) was one of two OECD countries where the average real annual growth of total health expenditure (3.7%) remained below the real annual growth of GDP (4.3%) between 1997 and 2007 (OECD 2009a). Between 1995 and 2009, public expenditure on health decreased not only in real terms but also as a share of total expenditure, falling from 84% to 69.7%. The latter percentage was lower than that of most central and south-eastern European countries, the Nordic countries and the UK, but similar to that in some western European countries, such as Spain and Belgium (Fig. 3.2). Taking into account that the informal economy has a larger share in 2004 2005 2006 2007 2008 Austria EU Slovakia Hungary
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Health Systems in Transition Vol. 1
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Health Systems in Transition Péter
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Contents Preface
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Preface The Health Systems in Trans
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Acknowledgements The Health System
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Health systems in transition Hungar
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xii Health systems in transition Hu
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xiv Health systems in transition Hu
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Abstract Hungary has achieved a suc
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Executive summary Introduction Hung
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1. Introduction 1.1 Geography and s
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5.0 4.5 4.0 3.5 3.0 2.5 2.0 Health
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5. Provision of services Health car
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6. Principal health reforms 6.1 Ana
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8. Conclusions Since the mid-1990s,
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10. Appendices 10.1 References Ád
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The Health Systems in Transition pr
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The European Observatory on Health
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