Hungarian Health Care structure and organisation Prof. Dr. Horváth Ildikó Head of Department of Health Policy
Hungary – key figures
Territory: Population: GDP:
93,036 km2 9 968 000 (estimate, May 2011) 190 billion USD (2010 estimate)
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Where do we come from?
State-socialist health services – until the end of 1980s
general taxation, comprehensive and universal coverage state owned delivery system managed by the Ministry of Health
Main features:
financing and service provision integrated publicly funded and provided health care virtually exclusive role both in financing (no private insurance, formal co-payments negligible, but informal payment) and service provision (only part-time private practice was allowed)
In principle everything was covered and available to everybody without any user charge – access, equity Excellent cost control
What have been implemented?
New social health insurance system based on the purchaser-provider split model, 1990. separate budget and administration: HIF, National Health Insurance Fund Administration contracts with providers coverage remained universal & virtually comprehensive Local government owned service providers (hospitals): 1990. New payment methods: capitation in primary care (1992), FFS in outpatient specialist care (1993), DRGs in acute inpatient care (1993), etc.
U
Ownership / system management
N
C
T
Service delivery
I
O
N
Financing / payment
Public health
CENTRAL GOVERNMENT
MINISTRY OF HEALTH
County
E V
Settlement
E
MINISTRY OF EDUCATION
MEDICAL UNIVERSITIES CLINICAL DEPARTMENTS
OTHER MINISTRIES
SPECIAL HOSPITALS, POLYCLINICS
COUNTY GOVERNMENTS
COUNTY HOSPITALS POLYCLINICS
MUNICIPALITIES
COUNTY BRANCHES
MUNICIPAL HOSPITALS
NATIONAL PUBLIC HEALTH & MEDICAL OFFICER SERVICE
COUNTY OFFICES
MUNICIPAL OFFICES
POLYCLINICS PRIMARY CARE SURGERIES
Primary care providers
Private Sector
Individual
L
NATIONAL AMBULANCE SERVICE NATIONAL INSTITUTES
L
N a t i o n a l
NATIONAL HEALTH INSURANCE FUND ADMINISTRATION
PHARMACIES PRIVATE OWNERS
PRIVATE CLINICS PRIVATE HOSPITALS
Patients
The Hungarian health system
F
Health policy priorities of the Hungarian Government
Responding to present and future challenges
Global financial and economic crisis scarce resources Demographic ageing growing disease burden, rising needs and expectations New disease patterns, although decreasing but still persistently high levels of NCD-related morbidity and mortality As regards communicable diseases, traditionally excellent epidemiological situation that should be maintained.
Urgent need for:
renewing the health care system strengthening public health policies
Problem-based policymaking: the concept
The key principles of problem-based policy-making: value-driven
for setting policy objectives evidence-based for evaluation and selection of appropriate reform measures, takes into account the feasibility of policy options
Problem definition
Evaluation
Actors Power Position
Policy formulation
Implementation Context
Prerequisites of problembased policy-making value consensus: consensus on objectives to be achieved (efficiency, equity, etc.) appropriate and accurate data (evidencebased policy-making) continuity in implementation
Fundamental conditions to success
Political commitment at national level on acknowledging that the health sector is not just a cost-centre, but also an active and critical contributor to economic progress health should be a central element of any wider socio-economic context
Growing relevance and importance of joint actions and sharing of knowledge, exchange of experiences and best practices at global, regional, local levels
Renewal of the Health Care System
New models of care should be designed and implemented responding to real local needs ensuring financial sustainability
Capacity
Real needs, demands
New concepts are emerging
accepting an appropriate system role for the hospital, but moving from hospitalcentric models looking towards greater integration of services, moving more care into local, accessible community settings
Financing options
Gyógyszerészeti és Egészségügyi Minőség- és Szervezetfejlesztési Intézet
Structure change - 2012 Reorganising
inpatient care Increasing the capacity on one-day surgery Strengthening outpatient services
Increasing efficiency (service and financial Improving
quality of care Defining progressivity, reallocation of duties and resources
Improving, strengthening safety Patient
care, working places Stepwise changes
Rapid, efficient resource allocation
Structure changes 2012 legal framwork
2011. évi CLIV. Tv., Megyei-Bp. átvétel („konsz.”) OTH 2012. 03.31. kapacitás és TEK felosztás Eütv. szakellátás biztosítása állami feladat 258/2011. Korm.r. „MIK” GYEMSZI 2012. 01.31. kapacitás és TEK javaslat Kapacitás max. 2011. 12.31. + ÚSZT előzetes, tartalék Térségi várólistás + ITO, PIC, SBO ill. ellátásonkénti TEK 2011. évi CLXXVI. Tv. „Eü.saláta” Ebtv, Eftv, Eütv. Térségi várólista, betegútszerv.-ért f. szerv (GYEMSZI) Orsz. várólista nyilvántartás, adósságmonit. (OEP) Térs. Eü. Tanács (2012. 05.01-től) Egyéb jogszabályok (Eü. korm. r. sal., ÖTv, NVTv)
Health Care Regions
Safety– Ambulance Service 22 (4NyD) new bases, Development 212 new ambulance car
Levels in inpatient care
Gyógyszerészeti és Egészségügyi Minőség- és Szervezetfejlesztési Intézet
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Timeframe of structure change GYEMSZI Professional
and service provider discussions 2011. spring, questionnaires, personal interviews, comments from the Medical Advisory Board Recommendation for territory of service: 2012. February Recommendation for progressivity Decision on activities at different progressive level
Resources 2012-14
ROP rehabilitation TIOP 2.2.2.Emergency, 4 Mrd Ft TIOP 2.2.4 Structure change, 44,05 Mrd Ft TIOP 2.2.5. Oncology, 6,8 Mrd Ft TIOP 2.1.3.Conversion from inpatient to outpatient, 10 Mrd Ft TIOP 2.1.1. Regional outpatient, 3 Mrd Ft KEOP Mental Health 5 Mrd Ft Primary service
Sürgősségi és traumatológiai ellátás a konvergencia régiókban
Sátoraljaújhely SO2
Ózd
Kazincbarcika SO2 SFH SO1 BAZ.M.Kh. SO2 TR3 MISEK
Salgótarján Balassagyarmat SO2 TR1
Mosonmagyaróvár SFH TRM
Sopron
Csorna SFH
SO2 TR2M
Esztergom SO2 TR1
SO1
GyőrTR3
Tatabánya
Körmend
SO2 TR1 Ajka
SFH
SFH Pásztó
SO2 Gyöngyös
SO2 TR2M
Zalaegerszeg SO1
Siófok SO2 TRM
Karcag SO2 TRM
SO1 SFH TR2 TR2 MÁV Kh.,Szolnok
TR3
Fehérgyarmat Nyíregyháza
SO2 SO2 TR1 Mátészalka
DEOEC
Szolnok, Hetényi G. MKh.
SO1
SO2 TR1
SO1 SO2gy TR3
SO2 Eger TR2M
SFH TRM Jászberény
Székesfehérvár
Veszprém
SO2* TR3
TR2
TR2
Pápa SO2
Szombathely
SO1
Kisvárda
TR1 SO1 Debrecen, Kenézy Kh. SO2gy SO1 TR3 SO2 Berettyóújfalu TR1
Dunaújváros SO2 TR1
SO1
SO2 Mezőtúr
TR3
Békéscsaba Szentes Kecskemét SO2 SO2 SO2 Keszthely Marcali TR2 SO2 TR2 SO2 Gyula Kalocsa SFH TR2 TRM TR1 Nagykanizsa SFH TRMKaposvár Hódmezővásárhely SO2 SFH SO2 Orosháza SO1 SO2 Szekszárd TR1 TRM Egészségpólus Kiskunhalas SO1 TR3 Makó Nagyatád Dombóvár SO1 SO2 TR1 Traumatológia ellátási szint TR2 Baja SZTE SFH TRM TR3 SO2 SO1 TRM Traumatológia mátrixban SFH TR2M TR3 PTE SO2 Szigetvár Jelenlegi, vagy ellátási szint SFH SO1 váltása nélkül fejlesztett SBO TR1 (pl. SO1) Mohács SO1 Fejlesztés utáni szint (pl. SO1) TR2
TIOP 2.2.2 fejlesztés TIOP 2.2.4 fejlesztés * Markusovszky Kórház: engedély SO1; szerződés SO2
TIOP 2.2.7 fejlesztés
A fekvőbeteg szakellátás fejlesztését szolgáló TIOP-2.2.7 és TIOP-2.2.4 konstrukciók nyertes pályázói
Sátoraljaújhely 2.2.4 Ózd 2.2.4
Kisvárda 2.2.4
2.2.7 BAZ.M.Kh.
2.2.4 MISEK Mosonmagyaróvár 2.2.4 Sopron 2.2.4
2.2.4 Gyöngyös
2.2.7 2.2.4 Tatabánya
Veszprém 2.2.4 2.2.4 Ajka
Siófok 2.2.4
Zalaegerszeg 2.2.4
Nagykanizsa 2.2.4
2.2.7
2.2.4 Eger
Győr
Szombathely 2.2.4
Nyíregyháza
DEOEC
2.2.7
Székesfehérvár 2.2.4
Szolnok, Hetényi G. MKh. 2.2.4
2.2.4Berettyóújfalu
Dunaújváros 2.2.4
2.2.7 Kecskemét
Békéscsaba 2.2.4
2.2.4 Hódmezővásárhely 2.2.4 Orosháza 2.2.4 Kiskunhalas
Kaposvár Szekszárd 2.2.4
2.2.7
Karcag 2.2.4
Baja 2.2.4
2.2.4
Gyula
SZTE 2.2.7
2.2.7 PTE Súlyponti kórház 2.2.7
TIOP-2.2.7 fejlesztés
2.2.4
TIOP-2.2.4 fejlesztés
Financing and payment reforms employee contribution
hypothecated health care tax
employer contribution deficit cover
HEALTH INSURANCE FUND
emergency services
patient transfer
acute inpatient care
family doctor services chronic inpatient care
outpatient specialist services medical aids
medicines
laboratory diagnostic services
etc.
chronic outpatient care
Input financing
Capacity financing
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Based on number of patient-beds or working hours Reduces patient records, motivated for cheaper diagnostic, therapeutic methods Become under-motivated in economic functioning, higher risk for under-treatment
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Task-financing
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Fixed estimates depends on concrete tasks Based on capitation or concrete care programs
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Gyógyszerészeti és Egészségügyi Minőség- és Szervezetfejlesztési Intézet
Output financing
Itemized financing
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Based on activity carried-out National outpatient financing
Normative financing
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Based on the result of the activity National inpatient financing Active – DRG’s
a.
- Increases efficiency, reduces care period b. Chronic- per diem allowance - Period of illness is not predictable Gyógyszerészeti és Egészségügyi Minőség- és Szervezetfejlesztési Intézet
Problem definition
Evaluation
Actors Power Position
Policy formulation
Implementation Context
Thank you for your attention
