Table 1 Overview of the Hungarian health care reforms in 2007

The reforms aimed to settle the eligibility criteria for the health for insurance coverage. According to the new regulations, the contributions of those who are eligible for services, but were not obligated to pay contributions (children under the age 18, students, pensioners, disability-pensioners, women on maternity leave) is to be covered by the state budget. Those who do not belong to these categories and who were either employees or self-employed workers are obliged to pay insurance contributions. The payment obligations have also been expanded to dependent family members and agricultural workers. According to the NHIFA’s estimations, the status of more than 1 million citizens in the NHIFA register was uncertain before the reform [18].

Changes in health insurance coverage

The introduction of co-payments. Co-payments for public health care services (called “visit fees”) were introduced in February, 2007 (~ 1.1 euro per visit and per day hospitalization). Children and some patients with chronic conditions were exempted. The revenues from these co-payments were retained by the health care provider. The aim was to make consumers more cost-conscious and to regulate demand for public health care services, as well as to eradicate informal patient payments in Hungary [17, 46].

Restricted choice of patients to use health care services. The government also aimed to enforce a system of referrals in the public health care sector. According to the regulation out-patient and in-patient care could only be accessed based on a referral issued at the lower levels of the health care system. In addition, patients’ choice of health care provider has been restricted. Patients could be admitted only to 2-3 hospitals in the region where the patients are living. Higher co-payments (30 percent of the hospital cost) should be paid, if patients wanted to attend hospitals (or physicians) in another region. (see Act 1997/ LXXXIII.)

A new act on pharmaceuticals

The Act on the Secure and Efficient Supply of Pharmaceuticals and Medical Aids and on the General Rules of Pharmaceutical Trade was adopted by Parliament in November 2006 (Act2006./XCVIII.). This reform was expected to reduce public expenditure on pharmaceuticals by 1) enforcing the role of patients in financing (i.e. by decreasing subsidies on pharmaceuticals) as well as the role of pharmaceutical companies (by the introduction of risk sharing mechanisms between payer and the pharmaceutical companies and the increasing taxes on promotion), 2) supporting generics by regulating the drug prescription system; 3) and to create price-competition between pharmaceutical companies by the liberalisation of the pharmaceutical market.

Decreasing subsidies and increasing co-payments. NHIFA reimburses drugs in three categories: 1) Fully reimbursed drugs 2) Indication dependent drugs 3) Normative reimbursement. The measure of the subsidies is a defined percentage of the negotiated gross price of the medicine. In 2007 reimbursements on pharmaceuticals were decreased. First, for drugs belonging to the category of normative reimbursement, the reimbursement rates have been decreased from 50 % to 25 %; from 70 % to 55 %; and from 90 % to 85 %. For drugs in the category of indication dependent pharmaceuticals the reimbursement rate of 90 % was reconsidered, and replaced by three subsidy categories (50, 70, 90 %). In the third category, where drugs are 100 % subsidized, a minimum 300 HUF co-payment per box was introduced [20].

Structural reforms

The new system of high priority and territorial hospitals was established in April, 2007 based on the Act . 2006./CXXXII. In total, 77 territorial hospitals and 37 high priority hospitals were set up. Structural reforms concerned the decease of the number of hospital beds in inpatient care as well. Acute bed capacity was cut by 16 000 beds (~ 27 %), while chronic bed capacity increased by 7500 (~31 %) in 2007 [21].

The establishment of Health Insurance Supervisory Authority

The Health Insurance Supervisory Authority (HISA) was established in December, 2006 to monitor contracts between the NHIFA and the providers. The Authority was also responsible for investigating patients’ complaints.