Health care in Hungary advancing, but more change is desired

The aging population may threaten the financial stability of the country’s insurance system.

ByMichael Piechocki

National Health Insurance Fund

Under Hungary’s system, ophthalmic surgeries are reimbursed by the government’s National Health Insurance Fund. Private insurance companies do not play a significant role in health care delivery.

Ophthalmic procedures are performed at clinics and hospitals. However, the operating center must be accredited by the National Health Insurance Fund.

Regarding ophthalmology, Istvan Cseke, MD, said reimbursement for cataract surgery covers only direct costs of surgery, such as the IOL and viscoelastic. Other costs related to practice overhead and technology upgrades are not included.

He said the health system slightly differentiates reimbursement rates based on technology used in surgery. For cataract surgery, more than 70% of cases in the country are performed using phacoemulsification. If a foldable IOL is also implanted, then a higher reimbursement category is created, “although the [amount] is just slightly more than the [amount] for a conventional PMMA IOL,” he said.

Both preoperative and postoperative office visits are covered, but patients have to contribute a copayment of 10% to 50% for medications.

Since changing to a democratic government in 1989 and 1990, Hungary has been making strides in reforming its political and economic systems. Health care has been reformed as well, although it has not received the same level of attention. The private practice of medicine remains underdeveloped, and both reimbursement rates and salaries for health care providers remain low, according to a Hungarian ophthalmologist.

According to Istvan Cseke, MD, a medical economist and head of the department of ophthalmology at Elizabeth Hospital in Sopron, Hungary’s health care system developed during the 1990s out of the centralized national health system that was in place during the Communist era.

The system currently provides universal coverage for all citizens, similar to some western European countries. All employed persons pay into a National Health Insurance Fund, which reimburses for procedures and examinations.

Dr. Cseke said he expects Hungary’s admission to the European Union on May 1 to have a prompt effect on only a few aspects of health care and ophthalmology.

He said he also expects legislation protecting doctors and nurses to be enacted as Hungary’s government aligns with EU standards, particularly in regard to medical and paramedical working hours.

Workers such as pilots and truck drivers already have protections that prevent them from being exploited or overtasked, but no such protections exist for health care providers.

“On the other hand, as health care is a national affair, European membership will result in other changes over a longer period,” he said.

Dr. Cseke noted that managers of Hungarian health care services are also anxious over a shortage of manpower in the country. The problem could decrease as the country aligns itself with EU standards for the practices of medicine and other areas of health care, such as salary.

He said that numerous specialists in other parts of the EU, such as Scandinavian countries, already receive salaries several times higher than those paid in Hungary. However, he noted that ophthalmologic professionals are not as affected as pathologists, anesthetists and radiologists.

Encourage private practice

According to Dr. Cseke, Hungary’s health care system has been going through a period of continuous reform since Hungary became a democracy.

Dr. Cseke said the country still needs to increase the role of private health care insurance. This would allow those patients who can afford such policies to access more services and receive better care, he said.

Before 1993, Hungary’s health care system had a centralized reimbursement, and it lacked elements of a free market system. All doctors were employed by the state, which restricted the growth of private practices. Doctors and surgeons could only do limited counseling with patients after performing their state responsibilities.

Eventually, advances in biomedical sciences and medical technologies increased costs beyond what the country’s solidarity insurance system could handle, he said.

“Functional privatization of [general practitioner] practices, privatization of pharmacy shops (100%), labors (50%), radiology units (25%) and the introduction of a reimbursement system based on output principles both in outpatient and inpatient settings are the most important steps [for reform],” he said.

Increase patient responsibility

Dr. Cseke noted that the population of Hungary is aging. This results in fewer people actively working and paying into the National Health Insurance Fund. As a result, the fund will have to provide care to an increasing number of retired or inactive persons.

“The system has to be changed [to provide a] differentiated level of care, with greater individual responsibility. Reimbursement could be an important element for increasing patient responsibility,” he said. For example, he said patients who are active in reducing their risk of diseases by attending regular screenings would have to pay less into social security.

He said copayments could also be increased to make patients more sensitive to the costs of care.

“This process is continuous, but from the unfulfilled socialistic idea — health care is a citizen’s right, and everybody has free access to it on the highest quality — it will be a long way and a hard job to form an effective, secure and individually acceptable health care system,” he said.

For Your Information:

Istvan Cseke, MD, is the head of the department of ophthalmology, Elizabeth Hospital. He can be reached at Sopron County Rank City, Elizabeth Hospital, Department of Ophthalmology, 15. Gyoriut, Sopron H-9400, Hungary; +36-30-969-0554; fax: +36-99-312-693; e-mail: csekist@sopkorh.elender.hu.