The Hungarian experience with implementing universal health insurance: changing roles and responsibi

1
The Hungarian experience with implementing
universal health insurance changing roles and
responsibilities
General Health Insurance in Financing of Health
Services in Turkey and Restructuring of the
Ministry of Health Istanbul, 31 March 1 April
2006

• Csaba Dózsa
• Ministry of Health
• Hungary

2
Structure of the presentation

• The National Health Insurance Fund (NHIF)
  structure and data
• Roles and responsibilities
• Strengths and weaknesses lessons learned
• Recommendations

3
Links within the health insurance system
Providers 33 thousands of doctors 6850 GPs 250
outpatient facilities 154 hospitals 2035
pharmacies
Patients, persons who entitled, Insured persons
(90 49,6?05 38,5)
11 of employer, 4 of employee contribution
The third party - payer NHIF Administration
1993-
Capitation, DRGs, German scores, visit fee, daily
fee
4
Benefits and services of the Hungarian Health
Insurance Fund

• Benefits in kind
• Curative-preventive provisions
• Primary care
• Dental care
• Outpatient care
• Acute and long-therm Hospital care
• Emergency services
• Home health care
• Kidney dialysis
• Reimbursement of medicines, medical devices, spa
  services, refunding of travel expenses

• Benefits in cash
• Pension-type social provisions right to their
  own pension
• - old-age pension,
• - disability and accident-related disability
  pension
• Benefits in cash
• Pregnancy and confinement benefit,
• child-care fee,
• sick-pay
• Accident-related provisions

5
Institutional environment
NHIFA
Budget
Other professional and social bodies Chambers,
patient associations
Health care providers
Taxes Contribu-tions

• - GPs
• hospitals - town, county, national, universities
• outpatient departments etc.

6
HIF expenditures in proportion of the GDP
1994-2005
7
Budget of the NHIFA 1994-2006
Deficit
Total Expenditure
Contributions
8
Structure of the expenditures 1994-2006
9
The main roles of the Ministry of Health

• Setting the strategy, the directions of the
  developments
• Operating the accreditation system
• Setting the minimal requirements for health care
  providers
• Publishing professional rules, protocols,
  guidelines
• Supervising the national institutes
• Coordinating the Professional Colleges

Info www.eum.hu
10
Structure of the MOH
Intensive professional connectionwith the NHIFA
11
The roles of the NHIF Administration

• Planning, operating the budget of the Health
  Insurance Fund
• Financing the health insurance benefits in kind
  and in cash
• Supervising and controlling the services in kind
  and in cash

Info www.oep.hu
12
Operational expenses of the NHIFA
13
The alternative roles of the NHIFA

• Administration role
• Controlling the bills and paying
• Financing role
• A little influence on the origin of bills
• Purchasing role
• To decide what, from who and how much to buy
• Real autonomy
• Insurance role
• risk management
• paying fees
• loss adjustment

14
Changing roles and responsibilities an example

• Announcement of the positive list of reimbursed
  drugs

Governmental order
2000
Ministerial order
2002
Announcement of the NHIFA
EU Accession 2004
There is a continuous changing of roles and
responsibilities !
15
The main challenges in the financing and
operating of the health insurance system

• The proportion of active/inactive, contribution
  payer/non payer population is getting worse,
  aging of the society
• Health needs and cost-containment the gap is
  increasing between health technology innovation,
  the evidence based and affordable services
• Basic package transparent coverage policy
• Strengthening the purchaser role quality
  effectiveness equity
• Incentives of services providers continuous
  changing of reimbursement methods
• Lack of human resources, specialization

16
(No Transcript)
17
Recommendations for the legal and administrative
environment

• Autonomy Semi-private legal form of the
  Administration
• Intermediate-term (3-5 year) strategy development
  and implementation with yearly action plans
• Set up a Supervisory Committee
• Separated, clear, well-defined roles between the
  Ministry of Health, Ministry of Finance and the
  Social security Administration
• Creating an independent health professional
  advisory committee for the SSA
• AND
• Continuous benchmarking looking at the
  international experiences and tendencies

18
Recommendations for the health insurance
organization

• Keep low of the operational-administration costs
• New Public Management Continuous
  quality-performance improvement
• Education of staff on IT, management skills,
  health studies
• Changing the staff between MoH and NHIFA
• Task improvement both centralised and
  decentralised
• Regional decentralisation with standard
  contractual system (ownership-neutral financing
  system)
• Centrally standardized information system and
  technology
• Efficient health professional and financial
  controlling system
• Evidence-Based Health care purchasing
  Transparent coverage policy to define the basic
  package, effective selection of old and new
  health technologies

19
Thank You for Your Attention !