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NDT Advance Access originally published online on April 27, 2006
Nephrology Dialysis Transplantation 2006 21(7):2024-2025; doi:10.1093/ndt/gfl156
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Public–private partnership in Hungarian dialysis care

Email: boncz.i{at}oep.hu

Sir,

We read with great interest the article by Rutkowski [1] on the epidemiology of renal replacement therapy in Central and Eastern Europe. Hungary belongs to the countries of Central and Eastern Europe where private dialysis centres entered into the market at an earlier stage, in the middle of 1990s.

From the point of view of the Hungarian National Health Insurance Fund Administration (the one and only healthcare financing agency in Hungary), we emphasize the increase in market share of private dialysis providers from health insurance reimbursement [2]. Figure 1 shows how the market share of privately owned dialysis centres increased from 46.3% in 1995 to 90.1% in 2004.


Figure 1
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  		Fig. 1. Market share of different types of dialysis providers from the health insurance expenditures between 1995–2004 in Hungary. (Source of data: National Health Insurance Fund Administration)

 
For the process characterized by the increased number of private dialysis centres in Hungary, we would suggest using the phrase private finance initiative (PFI) or public–private partnership (PPP) [3] instead of privatization. Privatization generally refers to the process whereby the owner (the state) sells its product or property to a private investor, but the Hungarian case preferred the mid-term (15–25 years) rent of existing dialysis centres; the private investors renovated the old centres or built completely new ones. Private investments were facilitated by the relatively sharp increase of reimbursement rates, which suggested a rapid return for investment [4], although since 2004, in addition to the activity-related financing, a global volume contract system was introduced in out- and in-patient care, forming an artificial financial ceiling for healthcare providers [5].

Beside the private investments, the relatively higher public reimbursement rates of the National Health Insurance Fund Administration—with the guarantee to spend it only on expenditures related to dialysis—contributed to the successful transformation and development of the Hungarian dialysis care over the past 15 years.

Conflict of interest statement. None declared.

Imre Boncz1, Andor Sebestyén2 and István Pintér3

1 Department of Health Policy National Health Insurance Fund Administration (OEP) Budapest2 County Baranya Health Insurance Fund Administration Pécs3 2nd Department of Medicine and Nephrological Centre University of Pécs, Hungary

References

  1. Rutkowski B. Highlights of the epidemiology of renal replacement therapy in Central and Eastern Europe. Nephrol Dial Transplant 2006; 21: 4–10[Abstract/Free Full Text]
  2. Boncz I, Dózsa C, Sebestyén A, Gulácsi L. Market share of the for-profit and not-for-profit sector from health insurance expenditures. In Hungarian: A profit-érdekelt vállalkozások és a non-profit szektor részesedése az egészségbiztosítási forrásokból. Orv Hetil 2004; 145: 1753–1757[Medline]
  3. Gaffney D, Pollock AM, Price D, Shaoul J. The private finance initiative. NHS capital expenditure and the private finance initiative-expansion or contraction?. BMJ 1999; 319: 48–51[Free Full Text]
  4. Mogyorosy Z, Mucsi I, Rosivall L. Renal replacement therapy in Hungary: the decade of transition. Nephrol Dial Transplant 2003; 18: 1066–1071[Free Full Text]
  5. Boncz I, Nagy J, Sebestyén A, Korösi L. Financing of health care services in Hungary. Eur J Health Econ 2004; 5: 252–258[CrossRef][Medline]

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This Article
Right arrow Extract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
21/7/2024    most recent
gfl156v1
Right arrow Alert me when this article is cited
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Right arrow Email this article to a friend
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Right arrow Articles by Boncz, I.
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