Mittwoch, 22. Oktober 2014

The Hungarian Health & Healthcare System

HUNGARY


Key Facts:

Size:  93.000 km² , Population: approx. 10.5 million
Capital:  Budapest (Population 1.7 million)
Public Expenditure on Health: 7.9 % of GDP (2013)

  • !      Roughly  5 million inhabitants living outside the country’s borders, having left after several waves of     emigration (WW I, WW II, Revolution of 1956) or because the live in areas that were Hungarian       territory before the 1920 Treaty of Trianon
  • !    Almost half of the country lives in communities of less than 20 000 inhabitants
  • !    At the last census (2001) 3.1 % of the population considered themselves to be members of a              minority. The Roma community has the biggest share, officially 190.000 in 2009, the real number is      estimated to be 500.000 or higher!


Governance:

-          19 Counties, recently divided into 7 larger „regions“ (each consisting of 2-3 counties)

-        
            After the communist regime fell, Hungary has had a stable political system with usually 4 parties in coalition. Since 2010 however,  2 parties (FIDESZ – Hungarian Civic Union & the Hungarian Democrat Party) have formed a 2/3 majority in parliament, and a radical right-wing party (JOBBIK) has also appeared.


Health Development in Hungary since WW II  -  4 Phases

Post-WW II to mid-60’s

Mátyás Rákosi
          („Stalin’s best disciple“)


       ·         major advances in socioeconomic improvements
       global immunization - > communicable diseases under control
       ·         the early public health efforts of the communist regime                    (including widespread immunization programmes) helped bring        communicable diseases under control
       ·         life expectancy at birth comparable to further developed, more        Western countries
Mid 60’s to Late 80‘s
The Kádár Regime a.k.a.
„Goulash Communism“

      ·         larger role of non-communicable diseases
      ·         whereas life expectancy continued to rise in Europe, it levelled         off (or, in the case of men) even decreased in Hungary
      ·          increasing health gap between Hungary and Western            
             Europe

Late 80’s to mid-90’s
Independence (1989)

      ·         Clear decline in health status, further widening the gap
      ·         Between  1890 - 1993, male life expectancy decreased by 1.5        yrs (unique phenomenon in central Europe)
      ·         Tougher transitional period than other formerly Communist              countries, such as Poland or the Czech Republic.

Mid 90’s to present
Prime Minister:
Viktor Orbán (FIDESZ)

·         Steady increase in life expectancy in men and women
·         Decrease in cardiovascular mortality
·         „A new era?“ (Jozán, 2009) – but the gap in life expectancy between Hungary and Austria (and other EU member states) has essentially remained unchanged


Health Status


 

2009
  • !      Hungary still ranks among the lowest in Europe in regard to life expectancy, trailing the EU average by 5.1 years, and lagging behind the EU27 and even EU12 for many health indicators
  • !      DALE (disability-adjusted life expectancy) 65.8 years (EU27: 71.7 years)
  • !      Ranked # 110 out of 156 in „World Happiness Report“ (only lower-ranked EU country: Bulgaria), Suicide rate still twice as high as the EU27 average
  • !      8.3 % of all males reported being heavy drinkers (2009), widespread consumption of illegally distilled alcohol may be an additional risk factor for liver zirrhosis
  • !       31.4 % of all population over 15 years of age were regular daily smokers
  • !      Persisting geographical & social inequalities, especially among the Roma Population

However…

Amendment of the Act on the Protection of Non-Smokers in effect since January 2012
The regulation bans smoking indoors with few exceptions, as well as in certain outdoor areas.

Opening of about 5.200 supervised tobacco stores, compared to more than 40.000 unsupervised retail outlets before, has made access to tobacco more difficult, which has already led to lower numbers of smokers aged 13-15. However, it is suspected that the tobacco business will increasingly move to the black market.

 


number of cigarettes smoked anually per capita: > 2000



Organization of the Hungarian Healthcare System:

·         Considerable departure from the centralized model in place during the communist era (where healthcare was state responsibility alone) and reinstallment of a Bismarck-type model in 1990
·         Single-Payer health insurance system with virtually universal coverage


Problems & Challenges in Hungarian Healthcare:

!      Lack of an overarching, evidence-based strategy for mobilizing resources for health. Without this, the health system reamains vulnerable to broader economic policy objectives.

!      HIF is responsible for recurrent health expenditure only, capital expenditure (both  maintenance & new investments) is the responsibility of the owners of healthcare facilities.  Poor general condition of hospital infrastructure & the legacy of an oversized hospital sector from the communist era, which resulted in downsizing. Still, the average hospital building is 50.5 years old and consists of 22 seperate buildings

!      Governance of the HIF has undergone several changes that have increased central control & reduced stakeholder participation, thus leading to less transparent and more unpredictable funding arrangements

!      Human resource crisis emerging due to the ageing of health care professionals, staff shortages and (due to poor salaries) increasing migration oft he healthcare workforce, especially among physicians.

!      As a result, physicians in Hungary are unevenly distributed both in geography and specialties. In contrast to the number of physicians, the number of dentists has increased by 56% between 2000 and 2008, because…

!      … Hungary is a target country in cross-border health care, mainly for dental care but also for rehabilitative services, such as medical spa treatment.

!      Difficulty in treating Roma population.





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