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

Health systems in transition Hungary 63
decreased and was stabilized at a low level (Table 3.1; see also section 3.4).
The second intervention was the reallocation of financial resources within
the health care budget, lowering the share devoted to curative-preventive
services (Table 3.2). Third, between 1998 and 2002 the government introduced
strict measures within the system of pharmaceutical subsidies, including the
requirement that prior authorization be obtained for overspending in the
pharmaceutical sub-budget of the HIF (1998/26), the extension of fixedamount
subsidies (2001/6), the lowering of wholesale and retail price margins
for expensive drugs (2001/2), and stricter controls over physician prescribing
(2001/3). The government in power between 2002 and 2006 continued to battle
against rising pharmaceutical expenditure and managed to negotiate a price–
volume agreement that made pharmaceutical companies financially responsible
for subsidized drugs sold in excess of an agreed volume limit (2003/21). In 2007,
as part of a general health care reform, several new measures were introduced
to address the financial imbalance of the HIF and relatively high share of
pharmaceutical spending by the NHIFA (see section 2.8.4).
The system of National Health Accounts is considered the official means
for collecting health care financing and expenditure data in Hungary, although
only through the OECD database (and not in the publications of the HCSO) do
data appear regularly and in comprehensive form. The two most significant
problems of the Hungarian National Health Accounts are related to estimating
private expenditure and classifying the public sources of revenues. First, the
true magnitude of informal payments in Hungary is unclear, with estimates
ranging from 0.06% to 0.6% of GDP (see also section 3.4). Second, in the
current version of the System of Health Accounts there is no distinction
between the sources of revenues for the health insurance system, although a
considerable amount comes from general tax revenues in addition to the SHI
contributions. This issue is discussed in greater detail in section 3.2. Finally, it
is worth noting that some reform measures have changed the structure of health
financing and expenditure without leading to any real increase or decrease in
spending. For instance, emergency ambulance and high-cost high-tech services
were transferred from HIF to central government financing in 1998 (1997/9,
1997/20).