COUNTRY FOCUS NEW PAVILIONS
Budapest. After joining the EU in 2004, widespread legislative, social, economic and financial reforms to improve performance of the health system and the health of the population were required to reach EU levels. Recent reform measures have been directed towards strengthening primary care and rationalisation of secondary and tertiary
care.Recently, Hungary has achieved almost universal coverage of its population with
H
and is divided administratively into 19 counties plus the capital
ungary has a land area of 93030 km2
mandatory social health insurance. In general, non-
communicable diseases are the leading cause of morbidity and mortality in Hungary, and lifestyle risk factors, such as smoking and a lack of physical activity, are prevalent. Excessive alcohol consumption is the main cause of high male mortality from cirrhosis of the liver.Unhealthy environments are also important contributors to poor health, with approximately 11.5% of the country considered polluted.On the contrary, communicable disease incidence is very low. Compulsory vaccination programs with extremely high coverage and an effective alert and response system for outbreaks have kept most diseases under control. Some of the challenges associated with the Hungarian Healthcare sector include: Precarious long-term
financial sustainability of the health insurance system is likely to have negative consequences for financial access and equity Ageing population and related increases in resources needs for the health system Rapid healthcare cost inflation and high expenditure on pharmaceuticals High prevalence of lifestyle-related risk factors, inadequate health promotion and preventative health services Human resource imbalance and lack of long-term investment plan for human resources Health sector reform bypass public health services and basic health functions, weak stewardship role of the MoH with regards to health promotion and prevention.
H
ealth reforms in Bulgaria started at the beginning of 1990s and were aimed at making the
Bulgarian health system more efficient and responsive to patients’ needs, by improving the quality of service and delivery of care. The establishment of the National
Health Insurance Fund and a basic benefits package defined the services covered by the public sector and earmarked the revenue collection for healthcare allowing for more sustainability of the healthcare budget. However, a financing system solely based on contributions
failed to provide enough funding for the system. Approximately one million people opting out of universal coverage meant that there were fewer contributors than beneficiaries and this led to potential adverse effects on the balance of the National Health Insurance Fund. Legalization of private practice had
a positive impact on access to health services and the resulting competitiveness between health care providers acted as an incentive for a higher quality of service provision. However, commercialization of healthcare and a stronger focus on market
relationships had an adverse impact on the social function of healthcare and gave rise to lack of motivation among providers. A restructuring primary care
and the introduction of GPs as gatekeepers to specialized care
allowed for cost-containment but led to a discussion on whether such policies dilute the principles of free provision and access to health care for the population. The restructuring of inpatient healthcare financing and provision was followed by the introduction of clinical pathways. This created better incentives for improving both quality and effectiveness of service provision. However, the actual cost of implementing clinical pathways for the hospital is higher than the price reimbursed by the National Health Insurance Fund, which causes financial instability in the inpatient sector.
Arab Health Issue 5 2011 23
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