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Current situation at the insurance market in Hungary (system of covering ST by insurance companies, perspectives, suggested strategies) dr Choma Balázs.

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Presentation on theme: "Current situation at the insurance market in Hungary (system of covering ST by insurance companies, perspectives, suggested strategies) dr Choma Balázs."— Presentation transcript:

1 Current situation at the insurance market in Hungary (system of covering ST by insurance companies, perspectives, suggested strategies) dr Choma Balázs National Health Insurance Fund Administration (NHIFA) Pharmaceutical Department Section of Medicine Prices and Reimbursement Hungary

2 Social insurance system in Hungary Pension Insurance Fund Health Insurance Fund

3 Health insurance in Hungary obligatory solidarity population entitled – insurees (by insured right) controlled market providers: public and private service profit-oriented insurance companies: complementary role

4 Revenues of the Health Insurance Fund contribution revenues (86%) employers insurees others central budget contributions (11%) other revenues (2%)

5 Expenses of the Health Insurance Fund

6 Finance of the healthcare provisions National Health Insurance Fund Administration (OEP) finance of the public health provisions is realized by the National Health Insurance Fund Administration monopoly

7 Advantages of monopoly homogeneous population large risk-community unified principles (guidelines) financial stability advantageous deal position etc.

8 Provisions and services of the Health Insurance Fund provisions in kind provisions in cash other expenses

9 Provisions and services of the Health Insurance Fund provisions in kind medicative-preventive health provisions subsidization of medicaments subsidization of therapeutical equipments spa provisions travelling expenses

10 Tasks of the medical preventive health provision system in Hungary services and duty of provisions of family doctors special treatment provision special treatment for out-patients special treatment for in-patients spa treatment

11 Substitution therapy in the health providers system 4 providers have reported ST to NHIFA Budapest, Pécs, Veszprém, Szeged out-patient care providers

12 Activity of the providers in 2002

13 Fee for output (HUF) in 2002

14

15

16 regionality is not succeded Budapest functions as a national centre

17 Methadone in pharmacies 1 product is available (Depridol) only for prescription not reimbursed for ST (100% for analgesia by cancer patients) 360 HUF/package (1,5 ) 2 DOT

18 Turnover in pharmacies packages were sold in 2002.

19 Sold packages in pharmacies ( )

20 Health insurance finance by tasks 1. Services and duty provisions of family doctors 2. Other primary care 3. Welfare officer duty, mother, child and youth care 4. Dental provision 5. Care in caretaker institut 5. Care in caretaker institut 6. Transport of patients and transport of the dead by right of medical prescription 7. Special care for out-patients 7. Special care for out-patients 8. CT, MRI 9. Kidney dialysis 10. Home special nursing 11. Blood supply 12. Special care for in-patients 12. Special care for in-patients 13. Other

21 Finance According to performance in-patient facilities: fee for uotput, DRGs out-patient facilities: fee for service

22 Finance of the addictology services in Hungary Metadon substitution treatment :300 points

23 Summary Problems between revenues and expenses complex public health program prevention not only a problem of insurance companies /more resources/ national task regionality

24 Thank You for Your attention!


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