Hungary: #25 in the 2020 World Index of Healthcare Innovation

Introduction

Hungary’s single-payer system ranks 25th overall in the World Index of Healthcare Innovation, with a score of 41.47. Hungary’s relatively low health care spending (6.6% of GDP) makes its system more fiscally sustainable than most. However, Hungary suffers in particular from poor Quality (43.61, #30) and Choice (32.97, #27).

Health outcomes are poor in Hungary. The average life expectancy in Hungary of 76.1 years is 4.9 years below the European Union (EU) average of 81.0, and mortality rates from heart disease, digestive system disease, and cancer are higher than the EU average. Lifestyle factors such as a traditionally unhealthy Hungarian diet, alcohol consumption, and smoking contribute to lower life expectancy. Hungarian infant mortality remains 20% above the EU average.

Background

Health insurance was introduced in Hungary in 1496, when groups of miners banded together to form mutual assistance funds known as bányatársláda. In 1854, Habsburg Emperor Franz Joseph I required all mining companies to establish such funds; in 1891, he established universal health insurance for industrial workers, along similar lines to the systems in German (established by Otto von Bismarck in 1883) and in Austria (in 1887).

This private system of sickness funds was abolished by the Communist Party in 1949, and replaced with a state-run system. Beginning in 1988, restrictions on private health care providers were eased, but the single-payer insurance system remained in place, with management eventually devolved to local governments.

Today, health regulations for Hungary’s single-payer system are almost exclusively formulated by the central government. The central government exercises strict control over revenue collection and sets uniform standards for providers, budgets, and payment. Nonetheless, municipalities are responsible for primary care, while the responsibility for secondary and tertiary care is shared among municipalities, counties, the private sector, and the central government.

Cost-containment has been the dominant focus of health policy reforms, with public expenditure on health care accounted for 5.2% of GDP in 2009. However, a human resource crisis and workforce shortage emerged as a result. Sadly, residents of Hungary are generally dissatisfied with their health system, and Hungary ranked 26th among 27 EU Member States in 2009 in terms of population satisfaction. Nevertheless, Hungary holds an excellent immunization rate, with virtually 100% coverage against childhood diseases.

Quality

The Hungarian health system offers poorer quality than its WIHI counterparts. Hungary ranked second to last within the overall quality metric at 30th. Notably, in the metric of measures of preventable disease, Hungary ranked last at 31st. Similarly, an aging hospital infrastructure ranked 24th, but Hungary scored considerably higher regarding patient-centered customer service.

Choice

The Hungarian health system ranked 27th overall regarding patient choice. In particular, the subcategories of health insurance affordability and access to technological services each ranked 28 of 31. Hungary’s freedom to choose health care services metric ranked higher at 20th. Nonetheless, Hungary’s single-payer system does little to offer comprehensive, robust patient choice.

Science & Technology

Hungary ranked collectively higher within the overall innovation metric at 19th. Notably, Hungary ranked 12th in medical innovation and 17th in national EHR adoption. However, the country ranked several spots lower regarding scientific innovation at 25th.

Fiscal Sustainability

A bright spot for the Hungarian health system was its overall fiscal sustainability at 13th overall. Most notably, Hungary’s growth of health spending as a share of GDP over the last decade ranked 10th, showing that a focus on cost containment since the global economic recession has proven somewhat successful. Similarly, the WIHI analysis found that Hungary’s public health spending per capita ranked near the top third at 12th. However, as a result of the lasting economic impact from the global recession on Hungary’s economy, Hungary’s debt-to-GDP ratio was relatively high, ranking it 20th.