Accession to the European Union will require Hungary to implement major changes to insure the heath care system remains intact. Changes that will also take into account the highest possible technological standards for the profession. Additionally, the demand for a competitive health care system is balanced by the necessity to retain an efficient work force.
These changes require serious contemplation about the values Hungarian’s have traditionally placed on health care. These include the financing from public funds, the free choice of physicians, a highly dedicated and well-trained health staff and universal access to health services.
These fundamental values, however, clash with the finance options of the system, and for this reason we must adapt to changing times.
In the long run, modernization of health care sets the fundamental target of improving the health of our population. We have to improve quality by focusing on the citizen as the “consumer” of health care services. Fair access to these services must be established and the quality of health care should be monitored with accountability.

What has the current government done so far?

The Hungarian Government has set up the ‘Health Decade Program Office’ in order to transform the system and establish accountability on a governmental level.
It has also raised wages an average 50 percent, and increased the number of health care employees by 2,000 in the first half of 2003. This measure is part of the government’s campaign promise to boost the resources of the health sector by HUF 150 billion in 2002 and 2003.
The 10-year modernization program requires an estimated HUF 1,500 billion. This surplus cannot be financed with tax and contribution revenues alone. It is essential to determine the ratio and rate of health spending, improve the targeting of resources and assure a more rational use of services by ‘clients.’ We would also like to see an increased participation of private financing in the system.
To attract investments, health service providers must also transform their ownership and financing structures, adjust capital management and focus on the concept of business management, transparency and accountability. These transformations will establish a material and organizational backbone for high quality treatment and care.
Hungary’s Hospital Law, in effect since July 1, 2003, also sets forth the conditions and legal foundations for the injection of capital into health care institutions in a transparent, monitored form. The government will operate an investment and information office that will determine guidelines for health care institutions as they act more like responsible business organizations. The purchase of services and the launching and operation of Public-Private Partnership (PPP) projects will be assisted by a database to facilitate partner searches.
Controlled and monitored participation of private resources in the modernization of the health sector will also be possible through these PPP programs. The government’s plan also envisages health sector employees acquiring ownership in health care institutions.
Efficient financial management and accommodation of private capital is fundamentally conditional on health care institutions starting with a “clean slate,” by settling their debt. When the comprehensive consolidation development program begins, a HUF 3 billion debt relief program will be implemented for 31 institutions.
We have also announced a HUF one billion ‘comfort development’ tender that will allow institutions to purchase facilities and equipment supporting patient services.
Other than institutional changes, the financing system will be transformed. We have done a variety of things to incorporate and settle controlled patient care experiments. Such experiments have been in social security financing, an outpatient care code, a more transparent and fair financing and effective monitoring policy and a re-regulation of the order of accommodation of specific services in social security financing. The burden of employers was also eased through a reduction of health care contributions.

Additional Tasks

In early August, the government specified the immediate tasks ahead. These are: to improve public satisfaction, promote informed consumer patient choices, enhance competitiveness and strengthen the ability of the National Health Insurance Fund (NHIF) in purchasing services.
Further changes will appear in contracts by insurers, as well as an establishment of competition between service providers. All organizations (irrespective of the corporate form) that meet the professional and financial requirements may apply to provide the services. The health insurer will conclude contracts on specific service types and quantities with these accredited institutions. To improve cost awareness and sensitivity of service providers, fees must be regularly verified and adjusted. We will eliminate administrative fund limits, enabling both activities and resources to shift in the direction of a population based, cost effective care. Fees, therefore, will better reflect the technological differences existing in the health care sector. We must thoroughly evaluate the controlled patient care model experiments. If we see that it improves health care conditions and promotes efficient spending, then they will be further expanded. As a result of easing the burden on the publicly financed system, along with developing consumers’ awareness on cost and value, we must promote the expansion of supplementary insurance.
At the moment, individual health services are privately financed on occasion with cash payment (commonly with gratuities). However, the rate of advance payments and flat fee (supplementary insurance) options is very low, which reduces social security in general and increases the vulnerability of the individual. Households are exposed to uneven encumbrances by the absence of adequate control, funding and consumer protection, with no guarantee of value and accountability.
To improve these conditions, as of Jan. 1, 2004, we will strengthen existing voluntary health funds to enable the financing of individual health check-ups and promote disease prevention. This will be implemented through the expansion of tax benefits.
Next year we will establish an institution of health accounts within the area of voluntary health funds. Health accounts serve the primary purpose of service financing and the payment of deductible as flat fees supported with tax benefits. The system of health accounts is devised to motivate holders to accumulate savings in advance for the coverage of future health expenses.
Demographic and sociological forecasts clearly suggest that nursing, particularly the nursing of the elderly, will pose an increasingly serious social problem in the future. To remedy the problem, we are elaborating a new nursing system that establishes a type of nursing insurance that relies on precautionary savings.
The transformation of the organization and financing of the health care system is also impossible without IT modernization. This will include the electronic health card, in compliance with EU standards. We are also planning the introduction of a call center and a web site where patients can receive answers to disease and medication-related questions.

István Gyorfi is Government Commissioner of the Health Decade Program Office