Current situation at the insurance market in Hungary

(system of covering ST by insurance companies, perspectives,

suggested strategies)

dr Choma Balázs National Health Insurance Fund Administration

(NHIFA)Pharmaceutical Department

Section of Medicine Prices and ReimbursementHungary

Social insurance system in Hungary

Pension Insurance Fund

Health Insurance Fund

Health insurance in Hungary obligatory solidarity population entitled – insurees (by

insured right) controlled market providers: public and private service profit-oriented insurance companies:

complementary role

Revenues of the Health Insurance Fund

contribution revenues (86%) employer’s insuree’s others

central budget contributions (11%)other revenues (2%)

Expenses of the Health Insurance Fund

Expenses of the Health Insurance Fund

0

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800

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1000

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Year

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ou

san

d m

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F

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%

Health insurance expenses, thousand million HUF In percentage of GDP

Finance of the healthcare provisions

National Health Insurance Fund Administration (OEP)

finance of the public health provisions is realized by the National Health Insurance Fund Administration

monopoly

Advantages of monopoly

homogeneous population large risk-community unified principles (guidelines) financial stability advantageous deal position etc.

Provisions and services of the Health Insurance Fund

provisions in kind provisions in cash other expenses

Provisions and services of the Health Insurance Fund

provisions in kind medicative-preventive health provisions subsidization of medicaments subsidization of therapeutical

equipments spa provisions travelling expenses

Tasks of the medical preventive health provision system in Hungary

services and duty of provisions of family doctors

special treatment provision special treatment for out-patients special treatment for in-patients

spa treatment

Substitution therapy in the health providers system

4 providers have reported ST to NHIFA

Budapest, Pécs, Veszprém, Szeged out-patient care providers

Activity of the providers in 2002

Number of registered ST

2 463

29

2 005

26 530

-

5 000

10 000

15 000

20 000

25 000

30 000

Pécs Szeged Veszprém Budapest

Centres

Fee for output (HUF) in 2002

724 122

8 526

589 470

7 733 964

-

1 000 000

2 000 000

3 000 000

4 000 000

5 000 000

6 000 000

7 000 000

8 000 000

9 000 000

Pécs Szeged Veszprém Budapest

Centres

Population lives in the environs of the providers

13%

10%

56%

21%

Szeged

Pécs

Budapest

Veszprém

Finance of the providers (HUF)

8% 0% 7%

85%

PécsSzegedVeszprémBudapest

regionality is not succeded

Budapest functions as a national centre

Methadone in pharmacies

1 product is available (Depridol) only for prescription not reimbursed for ST (100% for analgesia

by cancer patients)

360 HUF/package (1,5 €) 2 DOT

Turnover in pharmacies

19733 packages were sold in 2002.

Sold packages in pharmacies (2000.01-2003.01.)

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Health insurance finance by tasks

1. Services and duty provisions of family doctors 2. Other primary care 3. Welfare officer duty, mother, child and youth care 4. Dental provision 5. Care in caretaker institut5. Care in caretaker institut 6. Transport of patients and transport of the dead by right of

medical prescription 7. Special care for out-patients7. Special care for out-patients 8. CT, MRI 9. Kidney dialysis 10. Home special nursing 11. Blood supply 12. Special care for in-patients12. Special care for in-patients 13. Other

Finance

According to performance

in-patient facilities: fee for uotput, DRGs out-patient facilities: fee for service

Finance of the addictology services in Hungary

Metadon substitution treatment :300 points

Summary Problems between revenues and

expenses complex public health program prevention not only a problem of insurance

companies /more resources/ national task regionality

Thank You for Your attention!