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dr Choma Balázs National Health Insurance F und Administration ( NHIFA)

Current situation at the insurance market in Hungary (s ystem of covering ST by insurance companies, perspectives, suggested strategies). dr Choma Balázs National Health Insurance F und Administration ( NHIFA) Pharmaceutical Department Section of Medicine Prices and Reimbursement Hungary.

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dr Choma Balázs National Health Insurance F und Administration ( NHIFA)

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  1. Current situation at the insurance market in Hungary(system of covering ST by insurance companies, perspectives, suggestedstrategies) dr Choma Balázs National Health Insurance Fund Administration (NHIFA) Pharmaceutical Department Section of Medicine Prices and Reimbursement Hungary

  2. Social insurance system in Hungary • Pension Insurance Fund • Health Insurance Fund

  3. 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

  4. Revenues of the Health Insurance Fund contribution revenues (86%) • employer’s • insuree’s • others central budget contributions (11%) other revenues (2%)

  5. Expenses of the Health Insurance Fund

  6. 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

  7. Advantages of monopoly • homogeneous population • large risk-community • unified principles (guidelines) • financial stability • advantageous deal position etc.

  8. Provisions and services of the Health Insurance Fund • provisions in kind • provisions in cash • other expenses

  9. 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

  10. Tasks of the medical preventive healthprovision 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

  11. Substitution therapy in the health providers system • 4 providers have reported ST to NHIFA • Budapest, Pécs, Veszprém, Szeged • out-patient care providers

  12. Activity of the providers in 2002

  13. Fee for output (HUF) in 2002

  14. regionality is not succeded • Budapest functions as a national centre

  15. 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

  16. Turnover in pharmacies • 19733 packages were sold in 2002.

  17. Sold packages in pharmacies (2000.01-2003.01.)

  18. 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 institut • 6. Transport of patients and transport of the dead by right of medical prescription • 7. Special care for out-patients • 8. CT, MRI • 9. Kidney dialysis • 10. Home special nursing • 11. Blood supply • 12. Special care for in-patients • 13. Other

  19. Finance • According to performance • in-patient facilities: fee for uotput, DRGs • out-patient facilities: fee for service

  20. Finance of the addictology services in Hungary • Metadon substitution treatment :300 points

  21. Summary • Problems between revenues and expenses • complex public health program • prevention • not only a problem of insurance companies /more resources/ • national task • regionality

  22. Thank You for Your attention!

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