Principles of Operation
The healthcare system enables the assurance of healthcare services and the realization of public health objectives. The purpose of healthcare is to assist the development and restoration of health, to obstruct its deterioration, and to facilitate the integration of people of reduced health into employment and into society.
Within the framework of healthcare services, we can find preventive services, including services for the prevention and early diagnosis of diseases. As part of preventive services, prevention of infectious diseases, screenings, environmental and occupational healthcare activities, as well as protective care of families and women are also part of the system.
The Healthcare System
The first line of defense of the Hungarian healthcare system is primary healthcare. In accordance with the Act on Healthcare, all patients shall be assured continuous long-term healthcare based on a personal relationship, in or near their places of residence, irrespective of gender, age or the nature of their illness. The important institutions of primary healthcare are: family practitioners, family pediatric practitioners, dental practitioners, on-duty services adjacent to services, health visitor services, and school health services.
Outpatient Specialized Care
One-off or occasional healthcare provided by a specialist physician upon referral from the physician regularly attending and caring for a patient, or on the self-referral of the patient, or continuous specialist care when the patient has a chronic condition not necessitating inpatient care.
General outpatient specialized care shall be provided without endangering the health of the patient, in a manner enabling accessibility and availability through regular public transportation (in the case of Hungarian nationals in the vicinity of their domicile; while in the case of EU patients as per specific regulations.) Different forms of outpatient specialized care shall be provided per administrative units (generally in cities) for a population, the proportion of which is defined by the frequency of certain diseases.
Facilities providing outpatient specialized care shall perform their activities autonomously, or in cooperation with other facilities, based on an operator’s license. In general, it is a prerequisite of using outpatient specialized care that physicians entitled to give referrals provide such a referral. Referring physicians – based on their own professional indications and the regulations on referral issued by the healthcare administration – may initiate the examination and treatment of the patient at the healthcare facility operating at a level of specialized care justified by the health of the patient.
With the exception of emergencies,those insured may use specialized care that can be used without a referral at a healthcare provider of their own choice, that shall have a valid financing contract in terms of the given outpatient specialized care. However, should the healthcare provider not be bound by a territorial responsibility to provide healthcare for the patient, it shall then be entitled to deny care in certain cases. If those insured intend to use outpatient specialized care dependent upon referral at a healthcare provider that was not designated in the referral at issue, then they shall be considered as not having a referral. In case those referred use certain care in a repeated fashion, the referral shall be valid until the time specified by the referring physician in the referral, but at least for 90 days; in other cases the referral shall be valid for 90 days following issuance.
Inpatient Specialized Care
Healthcare provided in an inpatient facility close to the domicile of the patient. It shall take place as specified by law, based on a referral by the physician providing the patient with regular care, an attending physician, or by the self-referral of the patients themselves.Inpatient care shall mean care provided in parallel with being admitted in an inpatient treatment facility without interruption for the purpose of diagnostics, treatment, rehabilitation or nursing (including long-term nursing care), or care provided for the above purposes during specific times of the day, or any one time or cure-like intervention, following which a specific amount of observation shall become necessary, and during the course of observation further immediate care is provided if necessary.
In certain inpatient facilities, the forms of specialized care are structured differently in each administrative unit. Different forms of inpatient specialized care are carried out by hospitals, clinics, national facilities, sanitaria and other institutions. These are provided based on the frequency of certain diseases, for a specific population, per administrative units, generally in cities.
General inpatient specialized care can be used based on referral given by physicians of healthcare providers financed by health insurance, or by such physicians to themselves or to their next of kin.
In terms of the order of referrals, the same rules shall apply to patients arriving to Hungary from the Member States of the European Union.
Except in the case of emergency, if patients use inpatient specialized care without referral or in a manner departing from the order of referrals, i.e. not at the healthcare provider designated therein, they shall be obliged to pay partial compensation fees as well. The amount of partial compensation fees payable upon using inpatient specialized care without referral or in a manner departing from the order of referral shall not exceed 100.000,00 HUF.
Treatment in an inpatient facility specified in Annex 5 of Government Decree 287/2006 (XII. 23.) on the detailed rules of non-emergency care to be provided based on a waiting list shall be provided based on an institutional waiting list.
Upon payment of partial compensation fees, patients shall have the right to have their free choice of a physician, as part of which right, patients are entitled to choose a physician different from the one assigned to them in accordance with the work order of healthcare facility.
The healthcare provider may determine partial compensation fees or supplementary compensation fees for certain types of healthcare services, of which it shall be obliged to inform those insured, before the provision of the given service begins. The rules of determining partial compensation fees and supplementary compensation fees, and in many cases their exact amount is set forth in Annex 1 of Government Decree 284/1997 (XII. 23.) on compensation fees for certain healthcare services to be used only upon payment of compensation fees. No valid departure from these rules shall be permissible.
Other Healthcare Services
Further healthcare services specified by law include on-duty, ambulance, patient transportation, nursing services, healthcare services satisfying special care needs, end-of-life care for terminal patients, rehabilitation, specialized care with medical devices, supply of pharmaceuticals, psychotherapy and specialized clinical psychology, non-conventional therapeutic and complementary procedures, other therapeutic services, expert services within the Healthcare Framework..