1/14 Issues of health care financing May 2003 Dr Gyula Kincses

2/14 Basic trends characterising 21st century societies Extension of life, transformation of society’s age structure ; Harmonisation of certain diseases with life, thereby increasing the proportion of people living with diseases and disabilities; Increasing demand to improve quality of life for people with disabilities; Expected leaps in the development of medicine and medical technology (genetic engineering, biotechnology).

3/14 Consequence of the trends The health care delivery system cannot be financed in a lasting and sustainable way based on traditional principles. Directions for solution: - specification and selection of risks treated by compulsory health insurance, - restructuring the resources of compulsory health insurance, - improving self-care, preference of health saving -specification of services and provisions.

4/14 Specification and selection of risks treated by compulsory health insurance Separation of risks having outside interest: occupational health, competitive sports Separation of other types of risks: nursing insurance Shifting of the costs of damages caused by a third party: traffic accident, physical injury etc. Deflection of voluntary risks to supplementary insurance: extreme sports, dangerous animals

5/14 Restructuring the resources of compulsory health insurance Elimination of health contribution (EHO), keeping the money within the sector. Restructuring the rate of employer-employee contribution. The principle “everyone possesses legal status based on demonstrable contribution payment” should be actualised. The principle “everyone is paid by whoever grants livelihood” should be in force. The system cannot be financed by contributions tied exclusively to wages. Budgetary support should be planned support rather than planned deficit. Settlement of the situation of those not living on wages.

6/14 Specification of services and provisions The service catalogue cannot be fully made, but - The authorisation order based on minimum conditions is taking this direction. - Financing rules (“book of rules”) are also suitable for specification of service package. - The “examination-therapy” procedural order is still an existing instrument. This issue will come up again in this conference in connection with innovation policy.

7/14 Improving self-care, preference of health saving

8/14 Inequalities in the health care system Considering social polarisation and the burden weighing on underprivileged groups, the rate of private financing is high in Hungary; Private financing is unevenly burdened and appears almost exclusively as incidental cash payment; There are great regional inequalities in the accessibility of the delivery system.

9/14 Health care system of different countries from the viewpoint of the equity of financing % Source: M. Schneider Gesundheitssysteme im internationalen Vergleich, OECH database. On the basis of data between 1994 and 1998

10/14 Restructuring the regulatory system of the health fund membership fee based on 100% solidarity principle, in place of the 40-60% mixed system for the public services of the health fund: - assessment of health status, screening, making of health plan - community prevention and life style programmes - organisation of services - consumer protection. Optional health account for members, though not only the health fund can manage health accounts.

11/14 Definition of health account The Health Account is a current account that is supported with tax benefits equal to the health funds at a specified account manager - financial institution - health fund - business insurer for which reimbursement can be performed in case of purchase at qualified service provider special professional enterprise

12/14 Services of the Health Account Health services in kind - obligatory share of services financed by social insurance - voluntary supplementary fee (hotel, meal etc.) in line with services financed by social insurance - services used at providers not financed by social insurance Purchase of drugs and medical aids, other medical technology products Nursing care Income-supplementing services following accumulation/deposit time (in other areas of social security, life annuity etc.).

13/14 Tax benefits of Health Account Health Account receives tax benefits equal to the health funds. Business insurance covering mostly health care services should also receive identical tax benefits. The rate of tax benefits – as health-oriented saving – should be determined in a common platform. Short-term “flowing” financing and health saving should be differentiated in tax benefits.

14/14 Stimulation of service market The condition for the spread of supplementary financing is the development of the service market. Consensus-based provider agglomeration with common accreditation. Extension of optimal co-payment system: - choice of doctor and institute (with the exception of primary care) -services without regional obligation to provide.

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