Hungary: #29 in the 2022 World Index of Healthcare Innovation

Introduction

Hungary’s single-payer system ranked 29th overall in the 2022 World Index of Healthcare Innovation, down from 27th in 2021 and 25th in 2020. Hungary ranked 15th in Fiscal Sustainability, primarily due to its relatively low healthcare spending (approximately 7.3 percent of its GDP). Nevertheless, Hungary earned low scores for Quality (30th), Choice (27th), and its global contributions to Science and Technology (24th).

Health outcomes in Hungary are poor. For instance, the average life expectancy in Hungary of 76 years is four years below the European Union (EU) average of 80. Moreover, mortality rates from heart disease, digestive system disease, and cancer exceed the EU average. Hungary’s lower life expectancy stems from lifestyle factors such as an unhealthy traditional Hungarian diet, alcohol consumption, and smoking. Furthermore, Hungarian infant mortality remains 20 percent above the EU average.

Background

The history of Hungarian health insurance dates back to 1496, when groups of miners banded together to form mutual assistance funds known as bányatársláda for the infirmed. Four centuries later, in 1854, Habsburg Emperor Franz Joseph I required all mining companies to establish such funds and, in 1891, he established universal health insurance for industrial workers. This insurance system paralleled the Bismarckian model implemented in Germany and Austria in the previous decade.

Nevertheless, in 1949, the Communist Party abolished Hungary’s Bismarckian model and replaced it with a state-run healthcare system. Four decades later, in 1988, restrictions on private healthcare providers eased, but the single-payer insurance system remained in place. In the years that followed, healthcare management eventually shifted from national to local governments.

Today, the central government in Budapest formulates regulations for Hungary’s single-payer system. The central government exercises strict control over revenue collection and sets uniform standards for providers, budgets, and payment. Nevertheless, Hungary’s municipalities are responsible for the administration of all levels of care. They are solely responsible for primary care, but counties, the central government, and the private sector share responsibility for secondary and tertiary care.

In a recent round of health policy reforms, Hungarian lawmakers focused on health cost containment. Approximately 7.3 percent of Hungary’s GDP goes to health care spending. However, Hungarian residents are generally dissatisfied with their health system. As recently as 2019, 71 percent of Hungarians were not very or not at all satisfied with their health system. Nevertheless, Hungary reports an excellent immunization rate, with virtually 100 percent coverage against childhood diseases.

Quality

Hungary scored among the lowest countries in Quality (30th), down one spot from a year before. In particular, Hungary struggled in measures of preventable disease (30th) and pandemic preparedness and response (28th). Similarly, an aging hospital system resulted in a very low ranking in the WIHI element for infrastructure (29th). Furthermore, Hungary’s score in patient-centered care dropped significantly from 2021, falling from 17th to 26th.

Choice

The Hungarian health system ranked 27th for Choice. While Hungary secured positions in the middle of the index for affordability of health insurance (18th) and freedom to choose healthcare services (17th), Hungary ranked near the bottom in its ability to offer patients access to new treatments (29th).

Science & Technology

Hungary ranked 24th for Science and Technology. Hungary achieved a respectable ranking in medical advances (15th) but lower rankings in scientific discovery (25th) and health digitization (28th).

Fiscal Sustainability

Fiscal Sustainability offered a relative bright spot for the Hungarian health system, scoring a respectable 15th. Notably, Hungary performed well in growth in public health spending (5th) due to economic austerity measures taken over the last decade. Additionally, Hungary ranked above the median for the public health spending (14th). However, the lasting economic impact from the global recession caused Hungary’s debt-to-GDP ratio to be relatively high and thus it ranked 20th in national solvency.