There are three key themes describing market access for medical technologies in Hungary:
- Reimbursement: payment mechanism via the DRG-adjusted budget, List of separately paid devices not covered by the DRG-adjusted budget, and fee-for-service for high value, low volume procedures
- Funding: coverage decisions by the National Health Insurance Fund (NEAK)
- Health technology assessment: HTAs by the Technology Assessment Department of the National Institute of Pharmacy and Nutrition (OGYÉI) in relation to the coverage decisions
Reimbursement for most hospital and day case services is predominantly financed via a global budget mechanism, adjusted for activity based on DRGs.
DRGs are determined by the combination of a procedure code (OENO) and a diagnosis code (ICD-10). OENO nomenclature and the Hungarian DRG system are maintained by the National Health Insurance Fund and updated annually.
Certain (high cost) devices are not covered by the DRG tariffs for the procedure. Rather, these devices are subject to national centralized procurement via public tenders and can be used only in specific hospitals, defined on the national level. Similarly, certain high value, low volume (performed in a limited amount of centers) procedures are paid on a fee-for-service basis directly by the State Secretariat of Health.
Hungary has no nationally defined list of health benefits which are guaranteed to the Hungarian population. Decisions on which treatment methods to use and which new technologies to introduce are made by the hospitals.
However, the key factor for market access is a positive coverage recommendation from the National Health Insurance Fund (NEAK). NEAK develops initial recommendations following an HTA-driven process that involves multiple stakeholders.
Health technology assessment
HTAs are performed by the Technology Assessment Department of the National Institute of Pharmacy and Nutrition (OGYÉI). Regarding medical technologies, these are mostly related to coverage decision-making.
Specifics for IVD tests
IVD tests performed in outpatient specialist settings are reimbursed on a fee-for-service basis using the OENO nomenclature.
How can MTRC help?
Development of reimbursement analysis (procedure coding, payment mechanism, reimbursement tariffs, policy and HTA considerations)
Development of an application for coverage within the social health insurance
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