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Reimbursement mapping: HUNGARY. 2011. Content. Key Economic Indicators Healthcare Overview Reimbursement Systems Market Access Funding Mechanisms HTA Decision makers, Acronyms and Links Austerity Measures 2011. Key Economic Indicators Hungary. Healthcare system overview 1/2.
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Content • Key Economic Indicators • Healthcare Overview • Reimbursement Systems • Market Access • Funding Mechanisms • HTA • Decision makers, Acronyms and Links • Austerity Measures 2011
Healthcare system overview 1/2 In Hungary, decentralisation was one of the main areas of reform, even if the central government remains the primary regulator of hospitals and health systems. The State supervises how the national health insurance fund is administered, can finance health investments through specific grants, regulates healthcare personnel and defines the general health policy. The State also owns and manages most tertiary care hospitals (university hospitals and national institutes). The municipalities are owners and now mange primary care facilities, outpatient clinics, and, in large municipalities, secondary care hospitals are under the counties. They are responsible for the day-to-day management and maintenance of these hospital establishments, as well as for access and planning of hospital care in their territory.
Reimbursement system GPs have a gatekeeper role towards the secondary and tertiary care provided by specialists. Outpatient care, an activity based point payment system is used for financing. The medical procedures are listed according to the ICPM (International Classification of Procedures in Medicine) code system of the WHO (World Health Organization) and each procedure has a point value. Acute inpatient care is financed through the implementation of a system similar to the American Diagnosis Related Groups (DRG): Homogén Betegségcsoportok, further referred to as HBCS. The Hungarian HBCS system covers all the costs occurring during hospital care, including diagnosis and therapy, drugs, wages (doctors, nurses, etc.), accommodation costs (heating, cleaning, meals, etc.) and costs of hospital management except for investment costs. In 2004, in addition to the activity based fee-for-service payment system in out-patient care and to the DRG like financing technique in acute hospital care, the so-called Performance Volume Limit (PVL) was introduced forming an artificial financial cap for the activity based financing of the Hungarian hospitals.
Funding Mechanisms DRG funding The reimbursement for medical devices in the inpatient sector is partly based on a DRG system (being part of the DRG weights). Although DRG reimbursement is an output based financing system the performance of hospitals is strictly limited through a hard volume cap. The cap on DRG outputs is in place since 2004. Since that the volume caps are lowered year-by-year. Only the costliest medical interventions, such as bone narrow transplants, are not included in the system. Faced with the inflation of hospital care and the poor regional distribution of healthcare, a new mechanism was introduce to contain, if not reduce, the overly rapid growth in hospital activity. Healthcare providers (hospitals as well s specialist doctors) are now reimbursed in full for activities corresponding to 98% of the previous year's figure, measured according to HDG. The reimbursement rate for activities above this threshold is then degressive.
Funding mechanism EXTRA-PAYMENTS • An additional system called “case financed budget” is dedicated to certain medical devices groups (e.g. pacemakers, ICD, DES, staplers, EP catheters, spine internal fixation implants, neuropacemakers etc.). These medical devices groups are reimbursed on top of the DRGs through a dedicated budget/hospital/year given by the HHIF – Hungarian Health Insurance Fund. The values of the used and reported devices are reimbursed monthly to the hospital by the HHIF – Hungarian Health Insurance Fund based on the purchase invoice, to the extent of afore-mentioned budget. • The process for the inscription of a MD in a DRG list or on the additional “case financed budget” list has not been regulated.
HTA • ESKI, HTA working group (national) set-up in 2004, HTA that aims at Market access of Pharma and Medical Aid Products. Every request submitted by manufacturer to the institution in charge should be reviewed by HTA working group. As a data they require RCTs, systematic reviews, and health economic data. HTA is link to funding and reimbursement. • HunHTA (national) set-up in 2007, HTA that aims at technology evaluation. HTA initiator is manufacturer. Selection criteria: the technology with high impact on HC budget's expenses. HTA isn’t link to funding and reimbursement.
Austerity measures Hospital budget cuts The hospitals (healthcare institutes) are constantly underfinanced in Hungary. The government had to modify the hospital budget during the year and had to arrange extra money for the hospitals in the last years. The hospital budget (2,7 billion € on 280 HUF/€ basis) is 1,65% bigger in 2011 than the estimates of 2010 (2,7 billion €) but 3% less than the modified estimates in 2010 (2,83 billion €). Price referencing General price pressure. There is a „fixing‟ procedure going on in case of the medical (therapeutic) aids mostly at the wound cares products. It means that different (e.g. size difference) product groups are contracted and the amount of subsidy is „fixed‟ to the (lower) reference product's subsidy. If the price difference is more than 50% compared to the reference price the price must be reduced otherwise the product will be closed out from the reimbursement system.
