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

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66 Health systems in transition Hungary Table 3.2 HIF expenditure by main categories, 1995–2011 Expenditure category 1995 2000 2005 2010 p 2011 p Total expenditure (current prices, billion NCU) 445.1 797.7 1579.9 1445.5 1462.3 Cash benefits (%) a 26.5 27.7 28.6 16.4 15.9 Health care (%) 62.0 69.7 69.7 80.4 81.29 Other (%) b 8.7 0.4 0.3 1.8 1.9 Administration (%) 2.8 2.2 1.5 1.4 0.9 Expenditure on cash benefits (current prices, billion NCU) 118.1 220.8 451.3 237.7 232.5 Expenditure on health care benefits (current prices, billion NCU) 275.9 556.3 1100.4 1161.5 1188.8 of health care benefits Curative services (%) 69.2 67.6 63.1 65.2 64.8 Pharmaceutical reimbursement (%) 25.7 27.1 31.7 29.7 28.9 Medical aids reimbursement (%) 3.9 4.1 4.0 3.9 3.8 Balneotherapy (%) 0.4 0.6 0.4 0.3 0.3 Other health care benefits (%) c 0.7 0.7 0.7 0.8 2.2 Source: NHIFA. Notes: a As of 2007, disability pension payments were transferred to the pension fund; b Includes transfer payments to the pension fund and costs of real estate property businesses; c Includes travel reimbursement, mother-milk supply, cross-border services; p Planned costs. Table 3.3 Trends in the expenditures of the curative service of the HIF by main categories, 1995–2011 Curative and preventive services 1995 1998 2001 2004 2007 2010 p 2011p Total (current prices, billion NCU) 190.7 298.9 410.0 654.6 718.7 757.6 770.1 Primary care (%) 10.7 11.0 10.0 9.2 10.1 10.3 10.5 Mother and child health services (%) 2.3 2.3 2.3 2.2 2.6 2.4 2.3 Dental care (%) 2.7 2.8 3.0 3.2 3.1 2.9 3.1 Care centers (%) 1.9 2.0 2.3 1.6 0..8 0.3 0.3 Transport of patients (%) – – 1.0 0.9 0.9 0.8 0.8 Ambulance service (%) – – – 2.7 2.9 3.0 3.2 Dialysis (%) 2.0 2.5 2.8 2.5 2.9 3.0 3.0 Home special nursing (%) 0.3 0.4 0.4 0.5 0.5 0.6 – Outpatient specialist care, including CT. MRI and laboratory services (%) 15.6 16.1 16.9 17.4 17.0 18.1 18.1 – Inpatient acute services (%) 51.2 53.4 52.4 50.8 46.8 46.0 45.0 – Chronic hospital services (%) 6.0 6.3 6.3 5.8 6.5 7.5 8.1 Source: NISHR, 2011b; p Planned.
Health systems in transition Hungary 67 3.2 Sources of revenue and financial flows Public expenditure on health in Hungary is financed mainly through a combination of SHI contributions and general tax revenue transfers to the SHI scheme. In addition, revenue from general and local taxation plays a significant role in financing capital costs, public health services and some expensive health technologies. Private sources of revenue include charities, NGOs and corporations, voluntary health insurance as well as a considerable share of OOP payments (see Fig. 3.4). In 2009, 58.8% of total expenditure on health was covered by the HIF (OECD, 2011). The revenue of the HIF is derived mainly from (a) SHI contributions, which, for employees, take the form of a proportional payroll tax that is split with employers; (b) general tax revenue transfers from the central budget; (c) direct payments from pharmaceutical companies (see sections 2.8.4 and 6.1.2); and (d) the hypothecated health care tax. This hypothecated health care tax was introduced in 1997 and consisted of two components: a lump-sum tax and a proportional tax. The proportional tax is levied only on income that is not subject to the SHI contribution (see also section 3.3.2). The lump-sum tax was eliminated at the beginning of 2010. The share of total health expenditure financed through central and local governments in 2009 was 10.9% (Fig. 3.5), but this does not capture (a) the tax revenue transferred from the central budget to counter HIF imbalance (see section 3.3.3) and (b) the hypothecated health care tax, which is also transferred to the HIF. If, however, we consider the real sources of revenue and not the agents through which the spending is administered, then the share of total health expenditure financed through general and local taxes in 2009 rises to 35%, while the share financed through SHI contributions would be 32.5% (Fig. 3.5). Interestingly if this latter approach is used when looking at earlier expenditure data, the share of total health expenditure financed from general and local taxes in 2002 and 2003 turns out to be even higher than that financed from SHI contributions. Although this might seem a rather peculiar way to pool resources in an SHI system, it is very much in line with recent trends in Europe – that is, to move away from exclusive reliance on labour-related social insurance contributions and use a mix of revenue sources for financing the health insurance system. This development, however, did not follow an explicit taxation policy strategy in Hungary until the recent financial crisis, when the government decided to radically reduce the SHI contributions and compensated this loss of revenue by increased general tax revenue transfers to the HIF (see section 3.3.2).
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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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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. 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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The Health Systems in Transition pr
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The European Observatory on Health
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