Hungary: #30 in the 2024 World Index of Healthcare Innovation

Introduction

In the 2024 World Index of Healthcare Innovation, Hungary’s single-payer system maintained its position at 29th, unchanged from 2022. The country achieved a rank of 15th in Fiscal Sustainability, largely due to its relatively low healthcare expenditure, which constitutes about 7.3 percent of its GDP. However, Hungary received modest rankings in other areas, earning 31st place for Quality and 16th for Choice, while its contributions to global Science and Technology ranked 23rd.

Health outcomes in Hungary are concerning. The average life expectancy is 76 years, which is four years shorter than the European Union (EU) average . Hungary also reports higher mortality rates from heart disease, diseases of the digestive system, and cancer compared to the EU norms. Contributing factors to the lower life expectancy include lifestyle issues such as the traditional high-fat diet, significant alcohol consumption, and prevalent smoking habits. Additionally, the infant mortality rate in Hungary is 20 percent higher than the EU average.

Background

The origins of Hungarian health insurance trace back to 1496 when miners created mutual assistance funds known as bányatársláda to support those who were infirm. This system evolved significantly over the centuries. By 1854, under Habsburg Emperor Franz Joseph I, all mining companies were mandated to establish such funds. In 1891, expanding upon the Bismarckian model similar to that in Germany and Austria, Hungary introduced universal health insurance for industrial workers.

However, the landscape of Hungarian healthcare underwent a dramatic transformation in 1949 when the Communist Party dismantled the Bismarckian model, instituting a state-run healthcare system. Although restrictions on private healthcare providers were relaxed in 1988, the country maintained a single-payer system. Over the subsequent decades, the management of healthcare transitioned from national to local government control.

As of 2024, Hungary continues to operate under a centrally regulated single-payer system. The government in Budapest remains pivotal in formulating healthcare regulations, overseeing revenue collection, and establishing uniform standards across various aspects of healthcare provision including provider budgets and payment systems. Despite central oversight, the actual administration of healthcare services is largely decentralized. Primary care is the responsibility of municipalities, while secondary and tertiary care involve a collaborative effort between county governments, the central government, and private entities.

Recent health policy reforms have concentrated on containing healthcare costs, which consume about 7.5 percent of Hungary’s GDP, slightly up from 7.3 percent previously. Public satisfaction with the healthcare system shows signs of improvement from these reforms and ongoing efforts to enhance service quality and accessibility. As of the latest data, the dissatisfaction levels have decreased by 10 percent since 2019. Hungary continues to excel in preventive healthcare, maintaining an immunization coverage rate of nearly 100 percent against major childhood diseases.

Hungary’s healthcare system employs a hybrid structure where state involvement is balanced with private sector participation. The government, through its stringent regulatory framework, ensures that there is uniformity in service standards while allowing some room for private providers. This system attempts to combine the efficiency of market mechanisms with the accessibility and equity of public service provision. The focus remains on improving the efficiency of public healthcare services, expanding the role of private healthcare providers, and integrating modern technology to enhance patient care and system management.

Dimension Performance

Quality

Hungary ranks among the lower-performing nations in Quality, positioned at 31st, which represents a decline of two spots from 2022. The country faces specific challenges in managing preventable diseases (31st) and in pandemic preparedness and response  (29th). An outdated hospital system has further affected Hungary’s performance, resulting in a 32nd place ranking for infrastructure. Additionally, Hungary has seen a significant decrease in its patient-centered care rating, dropping from 17th in 2021 to 28th.

Choice

The Hungarian health system ranked 23rd for Choice. While Hungary secured a position in the middle of the index for freedom to choose healthcare services (16th), Hungary ranked near the lower quartile in its ability to offer patients access to new treatments (24th) and in affordability of health coverage (24th).

Science and Technology

Hungary is ranked 23rd overall in Science and Technology. In specific categories, Hungary has shown commendable performance in Medical Advances, securing the 12th position. However, it stands at 25th in Scientific Discoveries, securing very few patents in the medical and biotech industries. Hungary also finished 28th in health digitization; the population is less digitally connected than most countries in the Index, hindering Hungarians from taking full advantage of electronic health records. 

Fiscal Sustainability

Fiscal Sustainability stands out as a relatively strong aspect of the Hungarian health system, achieving a commendable 15th place. Hungary has seen positive results from economic austerity measures over the past decade, particularly in both its level of public health spending (14th) and growth of public health spending (14th). Despite these strengths, the prolonged economic effects of the global recession have led to a relatively high debt-to-GDP ratio, placing Hungary 20th in national solvency.