Hungary health system review.

Abstract

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. Although there have been substantial increases in life expectancy in recent years among both men and women, many health outcomes remain poor, placing Hungary among the countries with the worst health status and highest rate of avoidable mortality in the EU (life expectancy at birth trailed the EU27 average by 5.1 years in 2009). Lifestyle factors especially the traditionally unhealthy Hungarian diet, alcohol consumption and smoking play a very important role in shaping the overall health of the population.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. In 2009 Hungary spent 7.4% of its gross domestic product (GDP) on health, with public expenditure accounting for 69.7% of total health spending, and with health expenditure per capita ranking slightly above the average for the new EU Member States, but considerably below the average for the EU27 in 2008. Health spending has been unstable over the years, with several waves of increases followed by longer periods of cost-containment and budget cuts. The share of total health expenditure attributable to private sources has been increasing, most of it accounted for by out-of-pocket (OOP) expenses. A substantial share of the latter can be attributed to informal payments, which are a deeply rooted characteristic of the Hungarian health system and a source of inefficiency and inequity. Voluntary health insurance, on the other hand, amounted to only 7.4% of private and 2.7% of total health expenditure in 2009. Revenue sources for health have been diversified over the past 15 years, but the current mix has yet to be tested for sustainability. The fit between existing capacities and the health care needs of the population remains less than ideal, but improvements have been made over the past 15 years. In general, the average length of stay and hospital admission rates have decreased since 1990, as have bed occupancy rates. However, capacity for long-term nursing care in both the inpatient and outpatient setting is still considered insufficient. Hungary is currently also facing a health workforce crisis, explained by the fact that it is a net donor country with regard to health care worker migration, and health care professionals on the whole are ageing. Although the overall technical efficiency of the system has increased considerably, mainly due to the introduction of output-based payment systems, allocative efficiency remains a problem. Considerable variations exist in service delivery both geographically and by specialization, and equity of access is far from being realized, a fact which is mirrored in differing health outcomes for different population groups. A key problem is the continuing lack of an overarching, evidence-based strategy for mobilizing resources for health, which leaves the health system vulnerable to broader economic policy objectives and makes good governance hard to achieve. On the other hand, Hungary is a target country for cross-border health care, mainly for dental care but also for rehabilitative services, such as medical spa treatment. The health industry can thus be a potential strategic area for economic development and growth.