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14 March 2025 | Country Update
Regulatory changes to the Hungarian national eHealth infrastructure aim to optimize access to outpatient care -
28 July 2023 | Country Update
A new outpatient pathway management tool is currently being piloted -
04 January 2019 | Country Update
Hungary has among the highest ranking of doctor encounters -
08 June 2015 | Country Update
“Green Corridor” through Diagnostics for Cancer Patients -
30 June 2012 | Country Update
A new reorganized system of patient pathways and hospital services came into effect on 1 July 2012
5.2. Patient pathways
To demonstrate how the Hungarian health system operates from the point of view of the patient, this section describes in detail the pathway taken by a patient with a typical case of chronic heart failure, including the first point of contact, the diagnostic processes and, ultimately, the treatment and care received. It is important to note that there may be significant deviations from this example due to professional and regional disparities.
- A 50-year-old male patient consults his family doctor, with whom he is registered, and complains of fatigue, difficulty breathing, swelling around the ankles and waking up during the night and needing to urinate. The progression of symptoms has been continuous, and it is the patient’s first visit with these complaints. The visit is free of charge.
- The family doctor performs several basic examinations, such as blood pressure, blood sugar and ECG, which are available on site in his practice. For laboratory testing, the patient is either referred to the laboratory responsible for the family doctor’s primary care district (through the territorial supply obligation), or the blood sample is taken on site and sent in by the doctor’s office. A referral from the family doctor is necessary for performing the tests.
- Once the patient has returned with the results, the doctor evaluates them and makes a diagnosis. If further diagnostic or treatment measures are beyond his competence, he refers the patient to an outpatient specialist, which in the case of our example patient is a cardiology unit.
- With the family doctor’s referral slip in hand, the patient visits the provider who delivers cardiology outpatient services under the territorial supply obligation. This provider is located either within an independent outpatient clinic or an outpatient unit attached to a hospital. Although patients are entitled to choose their health provider and doctor in accordance with the provisions of Act CLIV of 1997, the right to free choice is constrained in many ways within the health insurance system by other regulations and by user charges. Providers of secondary care are not allowed to refuse treatment to patients within their catchment area, but may do so for patients outside their catchment area who are seeking elective interventions. If a provider has enough capacity, however, patients living outside their catchment cannot be turned down either. Within hospitals, patients may freely choose their physician, albeit subject to the provider’s operational rules (1997/20). The choice of an inpatient care provider and physician is subject to a 30% co-insurance, with a ceiling of HUF 100 000 (about €360) (2006/9, 2006/17, 2007/4).
- In cardiology, a specialist coordinates the care, makes the final diagnosis, determines the appropriate treatment, and decides which level of care (inpatient or outpatient) is required for the patient. In Hungary, it is typical for inpatient and outpatient care to be integrated – that is, they use the same human resources and infrastructure within the same organization. This being said, there are also a number of independent polyclinics.
- After the patient has completed specialist treatment, the specialist prepares a discharge note, with which the patient returns to his family doctor. From this point onwards, the family doctor is responsible for coordinating the patient’s care according to the treatment plan recommended by the specialist. Because the specialist’s attestation of the diagnosis is valid for six months only, patients undergoing long-term therapy must visit their specialist at least once every six months. Unfortunately, there is no seamless national information system for medical documentation accessible to providers at every level of care; family doctors can only obtain secondary care treatment documents that are handed over to them by the patient.
All the services mentioned above, with the exception of the free choice of hospital and physician and any outpatient medication, are currently covered by the HIF and are therefore free of charge. Certain outpatient specialist services do not require a referral from a family doctor (see section 5.3).
New rules related to the digital appointment booking system of the Hungarian National eHealth Infrastructure (EESZT) require outpatient providers (who use the booking system) to offer all available appointments for non-urgent care in the booking system. Exceptions include appointments reserved for in-house referring physicians, check-ups and special care procedures performed only by certain providers.
Not all outpatient providers currently use the digital appointment booking system, though the number is growing [1]. The new rules offer financial incentives for outpatient providers offering specified imaging procedures, allowing an increase in their planned annual budget if they use the booking system.
The rules, published in March 2025, aim to enhance the efficiency of the digital appointment booking system [2]. Although the Hungarian healthcare system follows the principle of territorial supply obligation, the new rules allow patients and physicians to book outpatient appointments with providers outside their assigned area.
Authors
Digital tools are increasingly being used to improve patient pathway management in the Hungarian health system. An update of the mobile application “Health Window” (Egészségablak, previously myEESZT) aims to assist patient-provider encounters. From 1 July 2023, all medical documents, including prescriptions, stored in the National eHealth Infrastructure (EESZT) became available to consult through the application. Furthermore, 30 providers around Hungary are currently piloting an outpatient pathway management tool. The tool, which the developer plans to integrate with both the EESZT system and the “Health Window” application in the coming months, facilitates appointment scheduling and on-site patient pathway management.
Authors
According to data from the OECD in 2016, Hungarians consult with doctors, including GPs and specialists, 11.1 times on average every year. This is the fourth highest number among OECD countries, and only Slovakia, Japan and South Korea have higher rates than Hungary. There is a huge gap between different areas in Hungary as well: while the Budapesters go to their GPs only five times a year, residents in northern counties visit their doctors almost nine times per year. GPs have a patient population of 1,600 people on average. The GPs treat 8-15 thousand people every year, which means 30 to 60 patients a day.
Authors
References
Hungarian Central Statistical Office: http://www.ksh.hu/docs/hun/xstadat/xstadat_eves/i_fea001.html
OECD: https://data.oecd.org/healthcare/doctors-consultations.htm#indicator-chart
A new regulation that came into effect on 1 June 2015, makes it mandatory for providers of CT and MRI scans to carry out examinations for patients with a well-founded clinical suspicion of a malignant disease within 14 days from the referral issue date. The referring specialist should agree on the date of the examination with the providers in advance, and indicate the “14 days’ rule” on the referral. If the diagnosis is confirmed, the examination will be reimbursed by the National Health Insurance Fund Administration (NHIFA) and the performance volume cap will not apply. If the diagnostic procedure cannot be accomplished by the provider with territorial supply obligation within 14 days, the patient can be referred to another, extraterritorial, provider, and the examination is to be reimbursed by the NHIFA on top of the performance volume cap.
Authors
References
Government decree No 124/2015. (V.26.) amending Government Decree No. 43/1999, Article 32/A.
National Health Insurance Fund Administration, 9/6/2015
According to the Ministry of Human Resources (which is the ministry responsible for health) the reorganization of patient pathways was necessary because patients were often not sent to the appropriate service providers. Eight regions have been established within which patient care can be provided from the basic to the highest level of progressivity. Patients can choose their healthcare provider within a region. Their choice will be monitored by the Ministry and it will be taken into account when hospital funding is decided. Providers chosen by more patients will receive more funding in the future.