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Country experience: Hungary:  health-related travel

14.230.        The Hungarian Central Statistical Office (HCSO) compiles services transactions between residents and non-residents. Data for business and transportation services are based on annual and quarterly conducted surveys by HCSO. The statistical units are the resident enterprises, Government and non-profit organizations, which supply services to non-residents and use services of non-residents. The surveys contain a list of 62 service types, including health services. According to the methodology, respondents should report all services of category 86 of the Statistical Classification of Economic Activities in the European Community (NACE) between residents and non-residents, provided by physicians, nurses and other qualified personnel working in health care. Even services provided from a distance, such as  laboratories  through the Internet, should be included. 

14.231.        The main data provider for health services is the National Health Insurance Fund (OEP). Among the other companies that reported export data for health services were university hospitals, air emergency rescue companies and pharmaceutical trade companies. According to an agreement between OEP and HCSO (and based on international methodology) the insurance fund export data cover emergency and other health services provided by Hungarian health institutes for foreigners in Hungary. The invoices are paid by foreign health insurance companies or by foreigners at the site. 

14.232.        Imports cover emergency and other health services provided by foreign institutes for Hungarians, invoices paid by OEP directly and services paid for by Hungarians at the site and reimbursed by OEP later. Health services for Hungarians who travel abroad for the verified purpose of medical treatment are considered to be part of the tourism service and are not reported here. The differences between the methodology of external trade statistics and the system of health accounts (SHA) have, as result, different values for the national health accounts of Hungary and the international trade in health services. In the trade statistics, the difference is part of the tourism services import. 

14.233.        Data on tourism expenditure is based on two surveys: a questionnaire on foreigners visiting Hungary and a questionnaire on travel abroad. The stratified non-probability sample, which excludes truck drivers, covers outgoing foreign and incoming Hungarian citizens who cross the border, including participants in package tours.  On a yearly basis, the average sample sizes are approximately 120,000 questionnaires for foreigners and approximately 50,000 questionnaires for Hungarians. The selection of days for data collection is systematic and casual. Data collection is conducted through personal interviews. The surveyed locations are 24 road border stations and Budapest-Liszt Ferenc International Airport. Participation in the survey is voluntary. 

14.234.        Out of the entire set of questions, two contain information that can be related to health care, namely the questions on the purpose of visit and on expenditures. The purpose of visit, among others, can be “medical treatment” and “spa, wellness”.  In the latter, both spending at spas based on a physician’s prescription and spending for the purpose of wellbeing or recreation should be accounted for. 

14.235.        However, the mechanical use of data from tourism statistics may lead to double-counting on the aggregate level, since household survey data (the Hungarian out-of-pocket expenditure data being based mainly on the household survey) contain all household spending whether it took place in the country or abroad, even though the household survey guide makes no reference to payments abroad. The exports of health services to non-residents are greater than the imports, given the lower prices of Hungarian health care providers.


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