Former Secretary of State, Ministry of Welfare, Hungary
From 1948, the dictatorship introduced a very strong centralised model for the Hungarian health care system. The traditional health insurance scheme, originating from the last century, was eliminated and the system was financed by the state budget. All independent providers organisations were dissolved and health personnel were employed by the State. The health care system structure comprised GPs providing primary care, specialised outpatient care and inpatient care.
The majority of the institutions were in the ownership of local councils and all GPs were employed by them. Over the past 40 years the financing of health care was based on the principle of capitation financing, with no assessment of productivity, or evaluation of effectiveness or quality of services, and it was characterised by political lobbying.
The first free elected Hungarian government has designed and introduced comprehensive health care reform in the country. The main principles of the reform were:
The introduction of the family physician system based on patients' free choice of doctor was aimed at strengthening preventive care. Half of family physicians were privatised in the two first years, contracting with the local municipalities and the National Health Insurance Fund.
Disease-centred care was replaced by citizen-centred care and treatment was shifted from the more costly inpatient care towards primary health care. This was supported by the new reimbursement system. The financing of family physician practices is tied to patients registering with the doctor of their choice, This is done by handing over the control stub of the insurance card and then receiving basic health screening. The accounting is based on age-corrected capitation with the following point values:
The sum of card points calculated on the above basis must be multiplied by a factor ranging from 1.0 to 1.4 depending on the doctor's qualifications and his/her period of service. To balance incomes and prevent the creation of excessively large practices, the value of card points declines progressively above 2800 card points (an average of 1800 patients). The practices receive a fixed sum of support for maintenance of the medical office depending on the nature of the practice and the number of locations.
The new reimbursement system is linked to free choice of doctors and the completion of basic patient screening documentation is the trigger for the settlement of accounts, safeguarding screening for all citizens registering.
The Ministry of Welfare supported the family physician practices with Personal Computers to assist the spread of medical informatics methods in primary care, while the National Health Insurance Fund pays a small allowance to practices that provide their data reports in computerised form. The public health significance of the data bank obtained in this way is inestimable. The new system will bring a change of historic significance in the field of public health.