1. The Hungarian Healthcare System Lecture 11 Tracey Lynn Koehlmoos, PhD, MHA HSCI 609 Comparative International Health Systems

2. Where are we now?

3. Some Updated Facts about Hungary Official Name: Republic of Hungary Capital: Budapest 19 counties, 20 urban counties, & 1 capital city Type of Government: parliamentary democracy Successful transition from centrally planned to market economy Continues to demonstrate strong economic growth Acceded to the EU in May 2004 Private sector accounts for over 80% of GDP.

4. Updated health status information Population: 9,981,000 (2006) Life Expectancy: 68.5 male/ 77.1 female— lowest life expectancy in OECD and Central Europe Infant Mortality: 8.4 per 1,000 Population >65: 15.2% Total Health Expenditures as % of GDP: 7.8 (2002) Per Capita Health Expenditures: $348 US

5. Morbidity, Mortality & Public Health Of the OECD nations Hungary is the leader by a wide margin for: –Deaths by respiratory cancers –Heart disease –Cirrhosis of the liver 44% of men smoke Highest alcohol consumption in Europe

6. Key Healthcare Financial Indicators Public: 70.2% –Health Insurance Fund (3% employee, 15% employer) Private: 29.8% –There are some options of Supplemental Insurance –Almost 90% of Private is Out of Pocket

7. On-going concerns High hospitalization rates, high number of specialists Fraudulent billing Counties with the highest need/lowest health status have the least amount of resources whereas counties (and Budapest) with the best health status have the highest amount of resources and spend the most on healthcare (Budapest spend 20% more per person per year than average)

8. Conclusion The OECD, WHO and other organizations have been forthcoming with making excellent health reform recommendations, which Hungary has adopted to some extent (2005 brought the 100 Steps program) Progress in Hungary has been painfully slow The only saving grace is the addition of Turkey to the EU and OECD mix—which makes the statistics coming out of Hungary not look quite so bad…

9. What can we learn from Hungary? Transformation from a centrally controlled tax-based system to a decentralized social insurance scheme (with a little taxation thrown in) (Similar to France) However…under the table payments are still prominent Highest death rate in central Europe— especially for Roma minority and rural residents