14 - Experiences with the application of the DRG principle in Hungary

Summary

A brief description of the Hungarian health care system

With the political changes in 1990, the Hungarian health care system changed from a Soviet-type health care system to the Bismarckian traditions of compulsory national health insurance similar to many other East European countries. After 1990, the responsibility for maintaining all levels of health care services was transferred from central to local government with a few exceptions (universities, national medical institutes).

Responsibility for the financing of health care services was given to the National Health Insurance Fund (NHIF), the only insurance fund in Hungary, and performance-related financing was introduced. As a general rule, NHIF finances the running costs, while coverage of capital costs is the duty of the owner of the health care institute, usually local government.

Most of the health care budget comes from contributions. Employees pay a contribution of 4 per cent of their gross income, and employers pay 11 per cent, without an income ceiling. In 1996 a “health tax” was introduced, which was a fixed, lump sum amount (currently 3,450 Ft/month/employee (approx. US$18.50); average income in Hungary is about US$600/month). This health tax is expected to be eliminated in the future. Although currently only about 38 per cent of the total Hungarian population pay health insurance contributions, the rest (pensioners, children, the unemployed, etc.) also receive health insurance coverage and are entitled to health care services.