There are around 6800 primary care physicians (GPs) in Hungary, covering the primary healthcare needs of a population of 10 million. One thousand five hundred of these GPs are paediatricians, primarily working in urban areas, 1600 GPs care for a mixed population, and the others treat adults only.
Previously, patients were allocated to local providers according to place of residence, and were only allowed to visit their official GP (panel doctor, district physician), who was employed by the municipality or the local (state-owned) hospital. According to regulations passed in 1992, patients may choose their own doctors, and GPs are free to form their own enterprises, financed per capita, directly from the National Health Insurance Fund (NHIF). Nowadays, this sum is c. 2000–3000 EUR a month. This amount covers not only the salaries of the doctor and practice nurse, but all other practice expenses as well. Many GPs work part time as occupational health physicians.
General practitioners have two contracts: one with the local municipality to supply care, and the other with the NHIF for financing. Financial rules are regulated by the government; there is no free market.
According to the law of 2000, title to practice was established, i.e., new GPs have to pay for the practice of their predecessor, either to the retiring physician or to the family if the previous GP has died.
There are no group practices in primary care; financial regulations do not allow it. GPs work in single-handed practices, employing one practice nurse. Cooperation in the form of a locum exists only between practices in the same office or area.
Some secondary care specialists can be reached directly by patients, others only by referral (neurology, rheumatology, radiology, laboratory, and sending to hospital), except in emergency cases. Secondary specialists are mostly civil servants, with fixed salaries, employed by the health services of the local municipalities or hospitals, which are financed by the NHIF, as fee for services. The same employment system exists in the hospitals as well.
Under the former socialist regime, it was common for patients to give extra money to doctors for treatment (tipping), in the hope of receiving improved care. The amount of tipping has decreased in the post-Communist era, but is still of great importance in hospitals, to avoid waiting lists and to honour underpaid staff.
In 2007, a health reform was planned and initialized in Hungary, forced by the coalition parties who were in power at the time. This reform was poorly communicated to the general public as well as among health professionals, and was attacked by opposition parties. Before these reform initiatives, every Hungarian citizen and all legal immigrants had free-of-charge access to the (primary) healthcare system.
From February 2007, patients had to pay a symbolic co-payment, a visitation fee (HUF 300, c. EUR 1.1), directly to the healthcare provider, for every consultation or each day spent in hospital. Many patients, however, were exempt, including those with diabetes, malignancies, and schizophrenia, as well as those under 18 years of age, patients with organ transplantation, and blood donors for transfusion purposes. From 2008, only patients whose insurance is covered by themselves or by their employers, or by the state (students, pensioners, unemployed), have free access to primary healthcare. It was planned that the single government-run Health Insurance Fund would be replaced by regional insurance companies, with partially private ownership and contribution.
After a long political campaign, in which the parliamentary opposition was supported by various civil movements, a nation-wide referendum was granted by the President of the Republic and by the Supreme Constitutional Court. People voted against the reforms; co-payment was abolished in April 2008, and private health insurance funds were not established.
Beside the enormous increase in administrative tasks, very little has happened in the last year.
The greatest challenges facing the Hungarian health system can be summarized as follows:
the recent governmental health reform initiatives were not made clear for the general public or for health workers, and the initiation and methods of the proposed reforms were poorly communicated, resulting in the reform being stopped by referendum;
there are no existing prevention programmes for expected lifestyle modification of patients;
there is a lack of new (mostly private) financial resources for changes in the health system;
besides low official salaries, the existing tipping system has a confusing influence on the rational and economic use of financial and human resources;
the enormous amount of paperwork, the administrative workload, and the number of useless reports for NHIF shorten the time available for consultations and curative procedures;
there is an ageing population of doctors, in almost all medical specialty (average age of GPs is over 57 years);
there is a lack of young doctors, rather than a turnover in generation, as many young and middle-aged doctors want to move abroad, in the hope of finding better-paid work;
there is no private investment in primary care---in the recent economical crisis, government support for the Hungarian primary care system is unlikely to increase.