Hungary______Health Care & Long-Term Care Systems

An excerpt from the Joint Report on Health Care and Long-Term Care Systems & Fiscal Sustainability, published in October 2016 as Institutional Paper 37 Volume 2 - Country Documents

Economic and Financial Affairs Economic Policy Committee Hungary Health care systems 1.13. HUNGARY

Overall, for Hungary no significant short-term General context: Expenditure, fiscal risks of fiscal stress appear at the horizon, though sustainability and demographic trends some variables point to possible short-term challenges. Medium risks appear, on the contrary, General statistics: GDP, GDP per capita; in the medium term from a debt sustainability population analysis perspective due to the still moderately In 2013, Hungary had a GDP per capita of 16.3 high stock of debt at the end of projections (2026), PPS (in thousands), below the EU average of 27.9. and the sensitivity to possible shocks to nominal Population was estimated at 9.9 million in 2013 growth, interest rates and the government primary and is expected to fall gradually to 9.2% by 2060, balance. Low medium-term risks are, on the a decrease of 7.5% in contrast with the average EU contrary, highlighted by the analysis of the increase of 3.1%. sustainability gap indicator S1, largely due to positive projected developments on ageing. Overall, Hungary appears to face medium fiscal Total and public expenditure on health as % of sustainability risks in the medium term. No GDP sustainability risks appear over the long run. Total expenditure (127) on health as a percentage of GDP (8.1% in 2013) has decreased slightly over Health status the last decade (from 8.6% in 2003, although it has been relatively flat since 2010), below the EU Life expectancy at birth (79.1 years for women and average (128) of 10.2%. Public expenditure is lower 72.2 years for men in 2013) is far below the than in 2003, 6.1% of GDP, though it has been respective EU averages (83.3 and 77.8 years of life relatively flat since 2007. It is also below the EU expectancy in 2013). However, healthy life years, average of 7.7% in 2013. at birth 60.1 years for women and 59.1 years for men, are closer to the EU averages of 61.5 and When expressed in per capita terms, total spending 61.4 in 2013. The infant mortality rate of 5 deaths on health at 1486 PPS is far below the EU average per 1000 live births (5‰) is higher than the EU of 2988 in 2013. So is public spending on health average of 3.9‰ in 2013, having gradually fallen care: 944 PPS vs. an average of 2208 PPS in 2013. over the last decade (from 7.3‰ in 2003).

As for the lifestyle of the population, the rate of Expenditure projections daily smokers was 26.5% in 2009, according to As a consequence of demographic changes, health Eurostat, although other sources provide estimates care expenditure is projected to increase by 0.8 pps of 31% in 2009 and 25.8% in 2014. According to of GDP, below the average growth expected for the Hungarian European Health Interview Survey, the EU (0.9 pps of GDP).(129), according to the the rate of current smokers was 31.4% in 2009 and "AWG reference scenario". When taking into 27.5% in 2014, (130). Since 2009 the total number account the impact of non-demographic drivers on of smoked cigarettes decreased by 8%, however in future spending growth (AWG risk scenario), 2012 the number of smoked roll cigarettes was health care expenditure is expected to increase by double compare to the previous result. The obesity 1.5 pps of GDP from now until 2060 (EU1.6). rate of the population was at 23.6%, in 2012, the second highest proportion in the EU (after Malta) and far above the EU average of 15.5% in 2013. (127) Data on health expenditure is taken from OECD health data and Eurostat database. The variables total and public expenditure used here follow the OECD definition under Alcohol consumption was 11.2 litres per capita in the System of Health Accounts and include HC.1-HC.9 + 2012, above the EU average of 9.8, and it has HC.R.1. decreased from 13.1 in 2003. According to the 128 ( ) The EU averages are weighted averages using GDP, World Health Organisation’s global status report population, expenditure or current expenditure on health in millions of units and units of staff where relevant. The EU on alcohol and health 2014 the pure alcohol average for each year is based on all the available information in each year. (130) European Health Interview Survey, 2014. (ELEF 2014); 129 ( ) I.e. considering the "reference scenario" of the projections Nemzeti Egészségfejlesztési Intézet: Egészségjelentés 2015 (see The 2015Ageing Report at (46.o.) http://europa.eu/epc/pdf/ageing_report_2015_en.pdf).

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consumption/year in Hungary (recorded and (including income supports of the unemployed), unrecorded) is in case of men 20,4 litre and in case social supports, persons whose ability to work is of women 7,1 litre (131). Among the European reduced at least by 50%. For those who fall under Union member states, Hungary is on the 5th place this category, the central budget transfers a with an alcohol consumption of 14,15 monthly amount of 5,790 HUF/person as health litre/person/year (total consumption) (132). service contribution into the Health Insurance Fund (HIF).

System characteristics Self-employed persons who perform activities in a complementary way or their joint ventures, and Coverage otherwise not insured or entitled persons are The health care system operates within the scheme obliged to pay a health care contribution (in case of a social security system based on societal of continuous residence in Hungary for a year - solidarity. A Bismarckian model of insurance has HUF 7,050 per month). Financing for groups been established: the main feature is the right to covered without contributing is provided by the benefits in exchange for contributions. Health central budget in terms of a fixed per capita fee. insurance contributions and direct government Dependant close family members or their spouses transfers provide the funding for cash benefits and are also obliged to pay health care contribution benefits in kind. Health insurance contributions are unless they are socially entitled, which must be proportional to income: In case of employees it justified by the local government (and their amounts to 7% of the gross salary (3 % cash obligation can also be undertaken). benefits, 4 % benefits in kind). The health care system covers virtually entire population (less than Persons not insured or not entitled to health care 1% is not covered). Membership is compulsory for can enter into contractual arrangements with the all residents. National Health Insurance Fund Administration (NHIFA - Országos Egészségbiztosítási Pénztár) Gainfully employed and assimilated persons are for entitlement to health care services. In case of insured against all risks: employees (including the adults, the contribution amounts to half of the public sector), the self-employed (including minimum wage, in case of minors and students members of co-operatives), several assimilated 30% of the minimum wage (only for benefits in groups, and beneficiaries of income subsidy, job- kind –not necessary Hungarian Certificate of seeker benefit and job-seeker aid paid prior to domicile). retirement. The government elected in 2010 opted for a Various groups of the not gainfully employed systematic move on the way to a national health population are entitled to health care benefits: service by further centralising the allocation of Minors permanently resident in Hungary, persons capacities; establishing a new hierarchical system who have fulfilled the minimum retirement age of actively managed patient routes; organising and whose monthly income does not exceed 30% more effective competition of generics in public of the minimum wage, homeless people, prisoners, purchases of pharmaceutics; and making steps full-time students, pensioners, beneficiaries of towards replacing contributions by taxes. various benefits, allowances, or income supports, persons placed in residential institutions providing Administrative organisation and revenue personal care, restrained persons, persons whose collection mechanism need has been recognised by the local government The health care budget is made up of three (131) components: (1) the budget of the HIF derived http://www.who.int/substance_abuse/publications/gl obal_alcohol_report/msb_gsr_2014_3.pdf?ua=1 from health insurance contributions and earmarked (132) health care tax (72% in 2016); (2) direct http://www.euro.who.int/__data/assets/pdf_file/0003 government transfers from the central budget (21% /160680/e96457.pdf - Annex 1 ADULT PER CAPITA in 2016) and other incomes (7% -social tax, ALCOHOL CONSUMPTION IN THE EU, CANDIDATE COUNTRIES, NORWAY AND SWITZERLAND (2009) incomes from pharmaceutical companies, accident tax, public health product tax).

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In addition, local government budgets are derived Authorisation and Administrative Procedures. from local taxes and from the central government Epidemiological and other public health issues grants for investment. The budget-setting belong to the National Public Health and Medical processes at different levels are practically Officer Service and its affiliates. independent, apart from central government subsidies for regional and local levels. The management of the provision of service and patient pathways is split between the level of A key principle is the institutional separation of NUTS3 administrative units and the higher level of capital and recurrent costs, which applies to all health-regions and nationally. Service providers, sub-sectors. While investment is decided upon and including outpatient and care centres manage financed by either local or central government, the patient pathways at lower levels. HIF covers recurrent costs only. All agents within this system are linked to the HIF, Since 2012, the hospitals owned by the capital, which is in charge of managing the finances of the cities and counties are state-owned. Dual financing health care system. The emergence of new still prevails, so recurrent costs are financed by the institutions in the management of patient pathways Health Insurance Fund, while capital costs by the means that the importance of the HIF as a central maintainer. However, as the National Healthcare institution in the health sector has been reduced. Its Service Center (earlier: National Institute for role has been further eroded by the partial Quality- and Organizational Development in devolution of responsibilities to a new network of Healthcare and Medicines) fulfils maintenance and government offices at NUTS3-level (known as supervisory duties over state owned health “government windows”). institutions. The level of expenditure on the administration of Restructuring was launched in 2011, and the such a system, where entitlements are not linked to operation of the new structure started as of 1 July contribution payments and virtually the entire 2012. The basic principle of the new structure is to decision-making power rests with the Ministry of centralise specialised care with high costs and Health, is not high. Public and total expenditure on relatively low patient numbers. Forms of care with health administration and insurance as a higher case numbers, being less specialised and percentage of GDP (0.11% and 0.11% less costly should be provided close to the respectively) is well below the EU average (0.27% population. A change of function or profile and 0.47% respectively in 2013). refining was introduced for 58 service providers. 4.3% of inpatient care capacities was closed. In Role of private insurance and out of pocket line with changes in structure, function and co-payments integration, a number of economic interventions aiming at improving effectiveness were introduced In 2013, private expenditure accounted for 36.4% - essentially contributing to sustained institutional of total health spending, considerably more than in functioning. Consequently, a part of resources the EU on average (22.6%). Also very large in made available could be reallocated to financing comparison to the EU average is the share of out- outpatient care. of-pocket payments (27.5% vs. 14.1% in the EU).

In 2011, the "Semmelweis Plan" reorganised the Types of providers, referral systems and patient health care system. The new structure basically choice centralised the administrative functions and system management under the responsibility of the State Health care provision is the state's responsibility. Secretariat for Health Care of the Ministry of The delivery system is organised on the basis of Human Resources (MHR) and related institutions "territorial supply obligation", which assigns the such as the National Institute for Quality- and responsibility to different levels of government Organizational Development in Healthcare and according to the principle of subsidiarity (the Medicines (at present: National Healthcare Service service should be provided at the lowest effective Center), the National Centre for Patient Rights and level of organisation). This way, municipalities are Documentation and the Office of Health responsible for providing primary care, while

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responsibility for secondary and tertiary health definitive care and avoid unnecessary referrals. care services is the central government’s Consequently, the number of referrals to responsibility. Nevertheless, even if obliged by law specialists and hospitals is high. Only the 2007 to provide a given level of care, the local reform (reducing impatient capacity of hospitals by authorities are not obliged to deliver it. Each level setting up a few regional universal hospitals and is allowed to outsource service delivery to private medical clinics, strengthening of the referral providers. Moreover, the owner of health care system and introducing a formal transparent facilities (whether private or public) is obliged to system of waiting lists) has allowed the authorities keep it in working order, i.e. to cover capital costs, to limit hospital overutilisation. Indeed, the which is particularly relevant in case of state- number of acute hospital beds per 100000 owned equipment and facilities being used by inhabitants is, at 399, above the EU average of private providers to deliver subcontracted services. 356. It has fallen since 2011 (414). Inpatient discharges per 100 inhabitants fell from 24.4 in Control, coordination, supervision and delivery of 2004 to 19.9 in 2011 (EU average: 16.5). public health services are the responsibility of the central government which provides the services Responsibility for secondary and tertiary care is through the National Public Health and Medical shared among different levels of local and regional Officer Service, in some cases in cooperation with government. Formally, the state (through the the other institutions. National Healthcare Service Center) owns large multi-speciality county hospitals providing Provision of primary care is within the area of secondary and tertiary inpatient and outpatient care responsibility of the municipalities. They may to the acutely and chronically ill. However, provide it through salaried doctors or contract the municipalities and central government also play a delivery to independent physicians, who need to role, the former being responsible for polyclinics have relevant qualifications and a "practice right" (outpatient specialist care), dispensaries (outpatient to be eligible. The "practice right" is the right to care for the chronically ill) and state-owned perform the professional activities, which can be hospitals (secondary inpatient and outpatient care), sold and bought by another qualified physician. By while the latter own – through specific ministries – establishing the territorial reach of the primary a number of acute and chronic hospitals. Dialysis care districts and the number of practices in each and home care have in comparison a significant of them, local governments can control the amount share of private ownership. and type of care provided to the population. Patients can freely choose a family doctor and Treatment options, covered health services change him/her once a year. Doctors cannot refuse the patients who live in their primary care district, Local authorities are required by law to provide but are allowed to refuse patients from other services at a given level of care. districts. Price of healthcare services, purchasing, A number of reforms have been enacted over the contracting and remuneration mechanisms last decade to provide incentives to take up the posts of physicians and nurses. The reforms have Family doctors can be employed according to four not produced visible results so far. Although different schemes: (1) municipality employee paid slightly higher than a decade ago, the number of on the basis of a monthly salary; (2) family doctor practicing physicians (321 per 100 000 inhabitants under a contract using public equipment and paid a in 2013), practising nurses (643 in 2013) and in capitation fee from the HIF; (3) family doctor particular general practitioners (34 in 2010) is still being an independent provider with no municipal well below the EU respective averages in the contract and no territorial supply obligation (large respective years (344, 837 and 78 per 100 000 majority of the GPs); he/she is entitled to a inhabitants). capitation fee from the HIF only if he/she has minimum threshold of registered patients; (4) Although there is an official referral system and "freelance medical doctor", not being subject to family doctors formally act as gatekeepers, the public employee regulations, but not having a payment system includes no incentives to provide status of self-employed private entrepreneur either;

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he/she receives an out-of-pocket payment directly HUF. Chronic care is financed by a daily fee. from the patient. Wages transfers are calculated by a monthly request of providers and it’s financed by the Capitation fees paid under schemes (2) and (3) are National Health Insurance Fund Administration. adjusted to the age structure of the patients covered: children and elderly weigh most, working Finally, in order to improve the income situation of age population least. Moreover, in order to avoid health workers, there was a wage increase started negative impact of the excessive practice size on in 2012 year and was continued in 2013-2015. the quality of care, a threshold of the number of patients is set above which the capitation payment The market for pharmaceutical products is only partial. Pharmaceutical spending accounts for 30.7% of The payment system in secondary and tertiary care total (public and private) current health depends on the type of institution and services expenditure and 20.2% of current public health provided. Outpatient specialist services are care expenditure in 2013. Reimbursement is financed by fee-for-service points, whereby each regulated while prices are (to some extent) freely procedure is assigned a number of points determined by the market (even if decisions on according to its complexity and requirement of reimbursement have impact on market operators' services and providers report total monthly number price policies). Prices of original drugs are of points to the HIF for reimbursement. The established on the basis of external price monetary value of a point is defined in advance, referencing (comparison with the prices in the and part of the sub-budget is put aside at the other EEA countries), while the maximum beginning of each year to compensate for possible generics' prices are additionally linked to the 'excessive' provision of services. The original drug price. Reimbursement applies to two sustainability of outpatient budget is achieved by a positive lists: one includes drugs which can be so-called performance volume limit. In the prescribed by any physician and are reimbursed at beginning of each year, based on previous years’ either 0%, 25%, 55% or 80%; the other includes data, the performance volume limit is defined for drugs with special indications, to be prescribed by every single outpatient health service provider. specialists and reimbursed at either 50%, 70%, Performance volume limit for the year of 2014 was 90% or 100%. Moreover, physicians are obliged to defined, in agreement with professional bodies. In prescribe reference medicines. 2016, 1 financing point equals to 1.50 HUF. Consequently, even if control mechanisms have The 2010-2012 reform of the pharmaceutical been set in place, the fee-for-service payment market launched in the context of the state debt scheme in hospitals could discourage treatment as reduction aimed at rationalising medication use an outpatient and encourage hospitals to treat as an and strengthening competition for generic drugs. inpatient for financial gain, rather than for the ideal The decision was made to improve the efficiency treatment of the patient. of the pharmaceutical reimbursement system in order to meet the needs of patients. In practice, this Inpatient services are reimbursed according to the also meant cuts in the pharmaceutical budget. A DRG-based prospective payment system, except number of austerity measures were introduced in for a few high-cost interventions reimbursed on a order to meet the budgetary constraints. In case basis. State owned hospitals are paid by particular these measures are: DRGs. In addition, there are income flows to hospitals for outpatient care, chronic care, • modified legal provisions regulating payment laboratory care and wages. Hospitals report the obligations for the pharmaceutical companies, total amount of completed procedures to the HIF which calculates their total value by multiplying • enhanced generic competition, the DRG points by the national base fee (value of one point) - set in advance for each year. The • requirements for enforcing patient compliance, sustainability of financing inpatient care is also ensured by the performance volume limit. • revision of pharmaceutical treatment protocols, Currently one single weight-point equals 150 000

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• re-contracting of volume agreements, and the increased substantially since 2012. However, they remain low in a European perspective. • introduction of prescribing by active substance. Challenges As a result of these measures, a substantial decrease in prices of pharmaceuticals in outpatient The analysis above shows that a range of reforms care could be realised during recent years, and have been implemented in recent years like for public expenses could be decreased without example to improve hospital efficiency and increasing the (even sometimes with decreasing) inpatient care supply or to promote the healthy life financial burden on patients. At the same time, a of the population in particular. Therefore, Hungary number of new innovative drugs could be included should continue to pursue them together with new in the reimbursement scheme. challenging reforms. The main challenges for the Hungarian health care system are as follows:

eHealth, Electronic Health Record • To improve the long-term sustainability of There is a relatively limited use of IT in the health insurance system, to avoid negative provision and organisation of healthcare. consequences for access and equity. This may mean improving the basis for more sustainable and larger financing of health care (e.g. Health and health-system information and considering additional sources of general reporting mechanisms/ Use of Health budget funds), with a better balance between Technology Assessments and cost-benefit resources and demand, between the number of analysis contributors and the number of beneficiaries Further measures to improve quality will include and which can improve access and quality of implementing a monitoring and evaluation system care and its distribution between population based on defined indicators. Major IT development groups and regional areas. If more resources plans include establishing a database for the are brought into the sector, it is important that insurance system, developing a personal they are pooled together through the strong identification system, improving remote pooling mechanisms in place today. diagnostics and telemedicine. • To foster effective coordination mechanism Healthy lifestyle and disease prevention activities between public entities responsible for have received a lot of attention mainly through investment decisions and providers actually programmes aiming at improving the health status using health care facilities. and quality of life of the population. Total expenditure on prevention and public health • To continue efforts to strengthen care services as 0.2% of GDP is about the EU average coordination, by promoting the role of GPs and (0.24% in 2011) while public. However, public avoiding unnecessary use of secondary and expenditure on prevention and public health tertiary care. On one hand, supply of human services as % total public current expenditure on resources to the primary care sector should be health is in line with the EU average (2.4% vs. fostered by providing an adequate set of 2.5% in 2013). financial (performance-related component added to the current capitation-based remuneration) incentives. On the other hand, Recently legislated and/or planned policy control and organisational measures reform strengthening the referral system should limit To reduce shortages of medical staff, a the use of specialist and hospital care. comprehensive residency support programme was introduced in 2011 and was announced again for • To develop the mechanism of updating the 2016. Beyond emigration, attrition puts further hospital payment system (relationship between pressure on skills shortages. To address this the actual costs of treatments and tariffs challenge, wages of health professionals were become outdated). A sector-wide survey has

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been conducted recently in order to tackle this problem.

• To strengthen monitoring and control by modernising and developing information technologies as well as by supporting human resources involvement in the decision making process. To introduce effective mechanisms for assuring quality of care: clear definition of tasks and competences of the health care providers (especially in the area of emergency care), more stringent conditions for licensing and accreditation, consistent development and application of medical guidelines.

• To strengthen efforts to promote healthy lifestyles, in particular by preventing smoking, excessive alcohol consumption, unhealthy diet and physical activity. Public health has been underlined as a priority in the development of recent health strategy for the health system. In this framework, the public health programme should continue, the importance of medical screening should be stressed.

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: : 9.7 0.5 7.8 7.7 0.1 3.9 -0.1 -0.4 27.9 77.4 98.7 61.5 3.01 0.19 2.24 1.44 0.32 2.62 0.18 0.13 0.19 14.1 83.3 77.8 61.4 0.24 0.47 1.80 0.27 10.1 0.96 2208 2013 2013 2995 9934 2013 2013 506.6 1.4 9.6 0.5 7.8 7.7 0.2 3.9 -0.2 28.0 77.2 14.9 2.99 0.18 2.25 1.55 0.31 2.61 0.16 0.12 0.20 10.1 99.7 14.4 83.1 77.3 62.1 61.7 0.25 0.41 1.71 1.07 0.27 2218 2011 2011 2911 9800 2011 2011 128.4 504.5 EU- latest national data EU- latest national data : : 9.8 0.6 3.2 8.1 7.9 0.2 4.2 -4.8 26.8 77.6 14.8 3.13 0.18 2.29 1.60 0.31 0.13 0.25 10.4 99.7 14.1 82.6 76.6 64.4 0.25 0.42 2.73 0.16 1.74 0.79 0.11 2009 2079 2009 2828 9289 2009 2009 502.1 : : 1.4 2.4 8.1 7.4 0.7 5.1 4.8 0.4 9.9 5.0 944 101 16.3 1.94 0.15 1.74 2.26 0.19 63.6 96.0 27.5 79.1 72.2 60.1 59.1 0.20 0.13 1.74 0.14 0.93 0.96 0.10 0.12 0.11 2013 2013 1486 99 8.0 7.5 0.4 5.0 4.7 0.2 9.9 4.9 873 219 -1.2 -1.9 16.2 1.94 0.14 1.73 2.49 0.19 62.5 10.9 96.0 29.1 78.7 71.6 60.5 59.2 0.26 0.13 1.73 0.13 0.91 1.04 0.10 0.13 0.11 2012 2012 1397 1.9 1.5 8.0 7.8 0.2 5.1 4.9 0.2 4.9 877 223 101 0.09 1.75 0.19 16.7 63.8 10.4 1.88 2.75 0.31 0.11 1.65 0.07 0.10 0.16 0.11 96.0 28.0 10.0 78.7 71.2 59.1 57.6 0.91 1.28 2011 1376 2011 98 1.3 5.5 7.8 0.2 5.2 5.3 8.1 5.0 0.2 811 111 0.18 16.5 64.8 10.2 97.0 1.91 0.09 1.76 2.65 0.35 0.11 1.68 0.08 1.29 0.09 0.20 0.11 27.0 10.0 78.6 70.7 58.6 56.3 0.92 2010 1324 2010 94 7.7 7.6 0.2 5.1 5.0 0.1 9.9 5.1 770 113 -3.1 -6.6 16.0 65.6 97.0 25.9 10.0 1.88 0.09 1.60 2.51 0.29 0.34 0.09 1.66 0.08 0.89 1.22 0.18 0.19 0.07 78.4 70.3 58.2 55.9 2009 1232 2009 1.1 7.5 7.3 0.2 5.0 4.9 0.2 5.6 780 108 114 -1.7 67.0 10.0 97.0 0.19 0.07 17.3 26.4 10.0 78.3 70.0 58.2 1.89 0.09 1.55 2.32 0.28 0.30 0.09 1.69 0.08 0.87 1.14 0.16 54.8 2008 2008 1221 0.3 7.7 7.4 0.3 5.2 5.0 0.2 9.9 5.9 102 749 119 -6.9 17.5 1.95 0.08 1.63 2.35 0.29 67.3 26.3 10.1 77.8 69.4 57.8 55.1 0.31 0.09 1.74 0.07 0.86 1.22 0.14 0.20 0.08 2007 1184 2007 100.0 91 1.8 5.7 4.1 8.3 8.0 0.3 5.8 5.5 0.2 790 121 17.8 69.7 10.7 2.08 0.08 1.81 2.56 0.35 0.34 0.09 1.82 0.07 0.22 0.08 25.0 10.1 77.8 69.2 57.2 54.4 0.92 1.60 0.20 2006 1204 2006 100.0 91 4.2 7.1 8.5 8.2 0.3 5.9 5.7 0.2 6.2 755 130 17.6 69.9 11.2 25.8 10.1 77.2 68.7 54.3 52.2 2.16 0.08 1.83 2.56 0.33 0.37 0.09 1.89 0.07 0.96 1.58 0.20 0.24 0.08 2005 1143 2005 100.0 : : 83 5.0 0.7 8.2 7.9 0.3 5.7 5.5 0.3 6.6 679 147 69.6 11.2 0.24 0.08 17.3 25.8 10.1 77.2 68.7 2.10 0.09 1.87 2.31 0.35 0.36 0.09 1.84 0.07 1.00 1.37 0.21 2004 1038 2004 100.0 75 4.1 8.6 8.3 0.3 6.1 5.9 0.2 7.3 982 659 158 17.3 17.4 71.1 11.5 26.4 10.1 76.7 68.4 57.8 53.5 2.25 0.10 1.96 2.29 0.33 0.41 0.10 1.96 0.08 1.06 1.45 0.18 0.27 0.09 2003 2003 100.0

Hungary

Statistical – Annex

EUROSTAT, OECDand WHO

1.13.1:

General context GDP GDP, in billion Euro, current prices GDP capita per PPS (thousands) capitaRealper GDP(% growth year-on-year) Real total capita healthper (% growth year-on-year) expenditure health* on Expenditure Total as %of GDP Total current as % of GDP Total capitalinvestment as% of GDP Total capita per PPS Public as % of GDP Public current as %of GDP Public capita per PPS Public capital investment as % of GDP Public as % total on health expenditure Publichealth on expenditure in %of total governmentexpenditure Proportion of the population covered public by primary or private health insurance Out-of-pocket on health expenditure as % of total on health expenditure Note: *Including also on medical expenditure long-term carecomponent, as reported in standardinternation databases, such as in the System of HealthAccounts. Total includes expenditure current plus expenditure capital investment. status health Population and Population, current (millions) Life expectancy at birth for females Life expectancy at birth for males Healthy life years at birth females Healthy life years at birth males Amenable mortalityrates 100 000 inhabitants* per Infant mortalityrate 1 000 lifeper births Notes: Amenable mortality rates break in series in 2011. characteristicsSystem GDP of % as expenditure current total of Composition Inpatient curative and rehabilitative care casesDay curative and rehabilitativecare Out-patient curative and rehabilitative care Pharmaceuticals and other medical non-durables Therapeutic appliances and other medical durables Prevention and public health services Health administrationand health insurance GDP of % as expenditure public current of Composition Inpatient curative and rehabilitative care casesDay curative and rehabilitativecare Out-patient curative and rehabilitative care Pharmaceuticals and other medical non-durables Therapeutic appliances and other medical durables Prevention and public health services Health administrationand health insurance Table Sources:

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1.0 0.8 1.6 0.1 9.8 6.2 6.3 344 837 356 15.5 22.0 78.3 70.2 16.5 30.4 7031 2013 2013 2013 2013 1.9% 3.3% 2.5% 4.9% 2.3% 1.6% 2.5% 3.5% 31.1% 23.2% 14.9% 34.0% 23.4% 12.5% 78 1.1 0.9 1.7 0.1 6.2 6.3 3.1 0.9 1.6 335 812 360 15.4 22.4 73.1 10.0 16.4 28.7 6530 2011 2011 2011 2011 3.3% 1.9% 2.6% 4.3% 2.1% 1.6% 2.7% 3.5% 31.3% 23.5% 16.2% 34.1% 22.3% 13.9% EUChange 2060 2013 - EU- latest national data EU- latest national data EU Change- 2060, 2013 - in % : 1.0 0.9 1.8 0.1 6.3 6.5 329 840 373 14.9 23.2 10.3 16.6 72.0 27.8 6368 2009 2009 2009 2009 3.2% 1.8% 2.6% 4.2% 2.0% 1.6% 3.2% 1.4% 31.8% 23.3% 16.3% 34.6% 22.0% 10.0% : : : : : : : : : 0.4 0.8 0.0 643 321 399 0.30 11.7 2013 2013 2013 2013 2.5% 2.1% 2.7% 1.8% 2.9% 2.0% 2.4% 2.4% 26.3% 23.6% 30.7% 36.6% 19.5% 20.2% : : : : : 0.8 0.4 0.0 5.2 632 309 398 0.28 23.6 69.2 11.2 11.8 2012 2012 2012 2012 2.6% 1.9% 3.4% 1.7% 2.6% 2.1% 2.7% 2.4% 25.7% 22.9% 33.0% 36.5% 19.2% 21.9% : : : 1,475

0.4 0.7 0.0 5.3 6.9 0.8 1.5 621 415 296 -7.5 0.30 11.4 11.8 19.9 71.1 2011 2011 2011 2011 2.4% 1.1% 4.0% 1.4% 1.5% 2.1% 3.2% 2.2% 24.1% 22.4% 35.3% 33.5% 18.5% 26.0%

Change 2060 2013 - : : 1,247

34 0.4 0.7 0.0 5.4 5.9 287 622 414 Change 2060, 2013 - in % 0.30 10.8 11.6 19.9 71.6 2010 2010 2010 2010 2.3% 4.5% 1.4% 1.2% 1.6% 1.7% 4.0% 2.3% 24.4% 22.5% 33.8% 33.4% 18.3% 25.6%

: 1,223

35 0.7 0.0 0.4 5.4 5.6 621 413 302 0.28 26.5 11.5 11.9 20.5 74.3 2009 2009 2009 2009 3.8% 1.2% 4.5% 1.2% 1.6% 3.6% 3.8% 1.4% 24.8% 21.1% 33.2% 33.5% 18.0% 24.6%

: : 1,110

9.2 0.3 0.7 0.1 5.6 5.4 5.4 6.2 309 615 413 0.28 26.1 11.6 11.3 20.4 75.3 2008 2008 2060 2008 2008 2060 3.9% 4.1% 1.2% 1.6% 3.2% 1.2% 3.9% 1.5% 21.3% 31.9% 26.0% 34.8% 17.9% 23.5%

833

: : : 9.3 0.3 0.7 0.1 5.6 4.0 5.4 6.1 595 416 280 0.28 12.6 10.8 20.6 69.0 2050 2007 2007 2007 2007 2050 1.1% 3.9% 4.2% 1.2% 1.5% 2.9% 4.0% 1.6% 26.3% 22.0% 31.7% 35.1% 17.3% 24.6%

594

: : : 9.5 0.3 0.7 0.1 6.1 2.5 5.3 5.9 620 555 304 0.26 13.2 12.8 23.8 70.0 2006 2006 2040 2006 2006 2040 1.2% 1.0% 4.3% 4.3% 1.1% 3.7% 4.0% 1.4% 26.0% 22.6% 32.0% 32.9% 16.6% 28.9%

527

: : : 9.7 0.0 6.3 5.1 5.6 0.3 0.7 2.2 278 595 554 0.26 12.9 24.6 76.0 12.9 2005 2005 2005 2005 2030 2030 1.0% 4.1% 4.5% 1.1% 1.2% 3.5% 4.2% 1.4% 26.4% 22.3% 31.3% 33.2% 16.8% 27.7%

481

: : : 9.8 0.3 0.7 0.0 6.5 2.0 4.8 5.0 578 553 334 0.26 13.1 12.5 24.4 77.0 2004 2004 2004 2004 2020 2020 1.1% 4.4% 4.5% 1.1% 1.3% 3.8% 4.4% 1.5% 26.5% 23.6% 29.1% 33.6% 18.3% 25.0%

: : : : 9.9 0.3 0.7 0.0 6.7 4.7 4.7 325 577 555 0.26 18.8 30.4 13.1 12.2 77.0 2003 2003 2003 2003 2013 2013 4.0% 4.9% 1.2% 1.3% 1.1% 3.1% 4.6% 1.6% 27.1% 23.6% 27.6% 33.5% 18.1% 24.8%

Hungary

– continued continued

Statistical - Annex

EUROSTAT,OECD and WHO

1.13.2:

Population projections until2060 (millions) Composition of total as % of total current health expenditure health current total of % as total of Composition Inpatient curative and rehabilitative care casesDay curative and rehabilitativecare Out-patient curative and rehabilitative care Pharmaceuticals and other medical non-durables Therapeutic appliances and other medical durables Prevention and public health services Health administrationand health insurance expenditure health public current of % public as of Composition Inpatient curative and rehabilitative care casesDay curative and rehabilitative care Out-patient curative and rehabilitative care Pharmaceuticals and other medical non-durables Therapeutic appliances and other medical durables Prevention and public health services Health administrationand health insurance Expenditure drivers life (technology, style) MRI units 100 000 inhabitants per Angiography unitsinhabitants 100 000 per CTS 100 000 inhabitants per PET scanners 100 000 inhabitants per Proportion of the population that isobese Proportion of the population that isa regular smoker Alcoholconsumption litres capita per Providers Practisingphysicians 100 000 inhabitants per Practisingnurses 100 000 inhabitants per General practitioners 100 000 inhabitants per Acute hospital beds000 inhabitants100 per Outputs Doctors consultations capitaper Hospital inpatient discharges 100 inhabitants