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Improving Health Outcomes and System in Hungary

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Improving Health Outcomes and System in Hungary OECD Economics Department Working Papers No. 961 Improving Health Outcomes Mehmet Eris and System in Hungary https://dx.doi.org/10.1787/5k98rwqj3zmp-en Unclassified ECO/WKP(2012)38 Organisation de Coopération et de Développement Économiques Organisation for Economic Co-operation and Development 23-May-2012 ___________________________________________________________________________________________ English - Or. English ECONOMICS DEPARTMENT Unclassified ECO/WKP(2012)38 IMPROVING HEALTH OUTCOMES AND SYSTEM IN HUNGARY ECONOMICS DEPARTMENT WORKING PAPERS No. 961 by Mehmet Eris All Economics Department Working Papers are now available through OECD's Internet website at http://www.oecd.org/eco/workingpapers English - Or. English JT03322123 Complete document available on OLIS in its original format This document and any map included herein are without prejudice to the status of or sovereignty over any territory, to the delimitation of international frontiers and boundaries and to the name of any territory, city or area. ECO/WKP(2012)38 ABSTRACT/RESUMÉ Improving health outcomes and system in Hungary Based on the latest available data up to 2009, the health status of the Hungarian population is among the poorest in the OECD, including countries with a similar level of income per capita. While this outcome has been driven by the socioeconomic status of the population and lifestyle risks, it also reflects the relatively limited effectiveness of the health care system, for which relatively low levels of resources have been available: total health spending amounted to 7.4% of GDP in 2009, lower than in other OECD countries with similar levels of income per capita. Although the health care system is generating significant health care outputs, such as doctor’s consultations and hospital discharges, problems with the quality of health services and the need to reallocate resources where they would contribute most to health outcomes suggest a need for reforms. Reforms are needed to address immediate challenges to stem the outflow of health care workers, reorganise care capacities, align incentives faced by providers and patients, and improve access to health care services. The medium–term challenge for the health care system is to increase available resources to significantly enhance health outcomes. As there are relatively weak mechanisms to regulate quality and prevent unnecessary care, further improving efficiency is also of key importance. This Working Paper relates to the 2012 OECD Economic Survey of Hungary (www.oecd.org/eco/surveys/hungary) JEL classification: I18, I14, I11 Keywords: Health care system, access to health care, spending efficiency, cost effectiveness, Hungary ************ Améliorer les résultats et le fonctionnement du système de santé en Hongrie Sur la base des données disponibles jusqu’en 2009, la situation de la population hongroise en matière de santé figure parmi les moins satisfaisantes de l’OCDE, même en tenant compte des pays où le revenu par habitant est similaire. Si ce résultat s’explique en partie par la situation socio-économique de la population et par les risques inhérents à son style de vie, il découle également du manque d’efficacité relatif du système de santé, dont les ressources sont assez faibles : en 2009, le total des dépenses de santé représentait 7.4 % du PIB, soit moins que dans les autres pays de l’OCDE présentant des niveaux similaires de revenu par habitant. En dépit d’un nombre important de prestations, dont témoignent, par exemple, les consultations médicales et les certificats de sortie des hôpitaux, les problèmes de qualité des services de santé et la nécessité d’une réaffectation des ressources vers des secteurs où elles pourraient contribuer au mieux à l’amélioration des résultats de santé suggèrent un besoin de réformes. Celles-ci sont nécessaires pour faire face aux défis immédiats : endiguer l’exode des professionnels de la santé, réorganiser les capacités de soins, harmoniser les incitations proposées aux prestataires et aux patients, et améliorer l’accès aux services de santé. À moyen terme, l’enjeu consiste à augmenter les ressources disponibles, de manière à renforcer sensiblement les résultats en matière de santé. Compte tenu de la faiblesse relative des mécanismes permettant de réglementer la qualité et d’éviter les prestations superflues, il est également crucial d’améliorer davantage l’efficience du système. Ce Document de travail se rapporte à l’Étude économique de l’OCDE de la Hongrie, 2012 (www.oecd.org/eco/etudes/hongrie). Classification JEL: I18, I14, I11 Mots-clés: Système de santé, accès aux soins de santé, l'efficacité des dépenses, efficacité-coût, Hongrie © OECD (2012) You can copy, download or print OECD content for your own use, and you can include excerpts from OECD publications, databases and multimedia products in your own documents, presentations, blogs, websites and teaching materials, provided that suitable acknowledgment of OECD as source and copyright owner is given. All requests for commercial use and translation rights should be submitted to [email protected] 2 ECO/WKP(2012)38 TABLE OF CONTENTS Improving health outcomes and system in Hungary ....................................................................................... 5 Health outcomes are generally poor ............................................................................................................ 5 The health system has been ineffective at improving the health status ..................................................... 10 Reforms of the health care system ............................................................................................................ 17 Bibliography ................................................................................................................................................. 29 Annex Health care system organisation ....................................................................................................... 33 ...................................................................................................................................................................... 34 Tables 1. Mortality rates for infants and by leading causes ................................................................................. 7 2. Health care expenditure for selected types of care ............................................................................. 15 3. Average monthly earnings of employees by sector of activity .......................................................... 25 Figures 1. Life expectancy indicators ................................................................................................................... 6 2. Health risks .......................................................................................................................................... 9 3. Mortality amenable to health care and health expenditure................................................................. 11 4. Health care consultations and hospital resource use .......................................................................... 12 5. Health care resources ......................................................................................................................... 13 6. Pharmaceutical expenditure ............................................................................................................... 16 7. Relative survival rates for cancer ....................................................................................................... 22 8. Age distribution of physicians ........................................................................................................... 25 A.1. Flow of funds in the health care system ............................................................................................ 33 Boxes 1. Policy recommendations to improve health outcomes and system in Hungary ................................. 27 3 ECO/WKP(2012)38 4 ECO/WKP(2012)38 IMPROVING HEALTH OUTCOMES AND SYSTEM IN HUNGARY by Mehmet Eris1 Health outcomes are an important determinant of well–being and, along with the efficiency of the health system, are intricately linked to economic outcomes. Healthy individuals are likely to enjoy longer and more productive lives and invest in their human capital, thus boosting the growth prospects of an economy. By contrast, in Hungary, excess mortality among the working–age population, driven mainly by cancer mortality, has been a drag on growth. Rising health care spending levels has become a cause for concern in the aftermath of the crisis, particularly in view of long–term pressures stemming from population ageing and long–term cost pressures. Although public spending on health in Hungary, at slightly above 5% of GDP in 2009 (total spending reached 7.4% of GDP), is not high in international comparison, limited fiscal space and the need to improve the delivery of health care services have heightened the urgency for reforms. In the following sections, after providing an overview of the health status of the population and its determinants (including those not directly associated with the health system), the performance of the health system is assessed in terms of outputs, including the number of doctor’s consultations and hospital discharges, and health outcomes, as measured by mortality and longevity indicators. The final section suggests various reforms of the health system with potentially large impacts on its efficiency and cost–effectiveness. Health outcomes
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