Major challenges ahead for Hungarian healthcare

BMJ 2011; 343 doi: (Published 07 December 2011) Cite this as: BMJ 2011;343:d7657
  1. Péter Gaál, associate professor 1,
  2. Szabolcs Szigeti, national professional officer on health policy and health systems2,
  3. Dimitra Panteli, researcher3,
  4. Matthew Gaskins, researcher 3,
  5. Ewout van Ginneken, senior researcher34
  1. 1Semmelweis University, Health Services Management Training Centre, Budapest, Hungary
  2. 2WHO Country Office Hungary, Budapest, Hungary
  3. 3Berlin University of Technology, Department of Health Care Management, Berlin, Germany
  4. 4European Observatory on Health Systems and Policies, Berlin
  1. Correspondence to: E van Ginneken ewout.vanginneken{at}
  • Accepted 1 November 2011

The health sector in Hungary is facing its most serious crisis since the fall of the communist regime. Péter Gaál and colleagues discuss the challenges and how to respond to them

Our recent review of the Hungarian health system laid bare some of the major challenges it faces today.1 Although Hungary’s problems are not unique, their size sets this nation of 10 million people apart. The country has some of the worst health indicators in Europe, and public funding of its health system, which has long been inadequate, is currently in decline. Out of pocket expenses are high and the system encourages informal payments. At the same time, the health workforce in Hungary is shrinking because of migration of skilled professionals, threatening the sustainability of the system. In this article we look at some of the successes and failures of recent health reforms and suggest a way forward.

System faced with poor population health

Since the collapse of the communist regime in 1989, Hungary has built a mixed health system, based on a single payer, the National Health Insurance Fund Administration (NHIFA), which is funded from payroll contributions and general taxes (box 1). The NHIFA contracts with local government owned providers and pays for the services on the basis of diagnostic related groups in acute inpatient care, weighted patient days in chronic inpatient care, and a fee for service point system in outpatient specialist care; primary care doctors get a fixed amount per enrolled resident, adjusted by age. Although general practitioners are meant to act as gatekeepers, payment incentives weaken this role and use of hospital services is high. Between 1995 and 2008, non-diagnostic referrals to outpatient specialist care almost tripled, and the number of hospital referrals per patient increased by 66.5%.2 Patients can consult a wide range of specialists without referral, including dermatologists, …

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