HUNGARY

Hungary has achieved a successful transition from an overly centralized, integrated Semashko-style health care system to a purchaser–provider split model with output-based payment methods. In the single-payer system, the recurrent expenditure on health services is funded primarily through compulsory, non-risk-related contributions made by eligible individuals or from the state budget. The central government has almost exclusive power to formulate strategic direction and to issue and enforce regulations regarding health care. Entitlement to benefits is based on these contributions. The contributions themselves are pooled in the Health Insurance Fund (HIF), which is administered by the National Health Insurance Fund Administration (NHIFA). The latter is the sole payer in the system. It is under the direct control of the state, has no discretion over revenue collection or budget setting, and has only limited discretion over purchasing decisions.
The central government has almost exclusive power to formulate strategic direction and to issue and enforce regulations. It exercises strict control over revenue collection, as well as in determining the benefits package, setting uniform requirements for provider reports, setting budgets, allocating financial resources, and engaging in contracting and payment.
Local governments own most hospitals and other health care facilities and are responsible for the capital cost of health services and for ensuring the provision of care. Private entrepreneurs and businesses play a central role in primary and pharmaceutical care and an increasing one in specialist care. The use of private capital in the provision of inpatient care, however, remains
controversial.
To date, health policypolicy-makers have had little success in influencing the organizational framework of other areas of public policy in order to create the appropriate organizational framework for setting intersectoral health goals. Moreover, although some efforts have been made to improve access to health services among marginalized sections of society, planned interventions to deal with health inequities within the wider framework of social determinants of health are still lacking.
Public expenditure on health is financed mainly through a combination of contributions and general tax revenue transfers to the health insurance scheme. There has been increasing reliance on the latter in recent years. Participation in the health insurance scheme is compulsory for all citizens living in Hungary, and opting out is not permitted. Based on the current legal framework, coverage should theoretically be 100%, but the health insurance status of approximately 4% of the population is unclear. The benefits package is comprehensive but not exhaustive. Both a positive and a negative list are currently in place. A considerable and relatively stable share of OOP expenses is attributable to informal payments, which are a well-known phenomenon within the Hungarian health care system. Voluntary health insurance does not play a significant role at present and has only supplementary and complementary functions.

Family doctor services are paid through capitation, outpatient specialist care through a fee-for-service point system, acute inpatient services through a payment system based on diagnosis-related groups (DRGs) and chronic care through per diem rates. Special rules apply to certain services, such as emergency patient transfers. Physicians are either salaried employees or private entrepreneurs contracted by the NHIFA, whereas other health professionals are mostly paid by salary.