In Hungary, the healthcare system is separated into two main parts, so-called “levels”. The first level is the primary healthcare or primary care, in- and outpatient care and facilities form the second level of the healthcare system.
The primary care’s function is to promote disease prevention and early diagnosis and it focuses on health promotion and education. When necessary, primary care provides medical treatment, nursing care, rehabilitation or referrals to specialists for further examination and treatment. Primary care is usually available locally, close to the patient’s home and no referral is needed.
The primary care’s scope of activities are:
- GP and GP Pediatrician care,
- dental primary care,
- on-call service related to primary care,
- health-visitor service,
- school physician service.
In- and outpatient care services – besides certain legal exceptions – are available based on a general practitioner’s referral for patients with social security coverage (social health insurance-covered).
Medical services available without referral
Some legally set out outpatient services are available without a referral.
The patient is eligible for the following out-patient services without a medical referral:
- dermatology;
- gynecology and child gynecology;
- urology;
- psychiatry and addictology;
- ENT, infant and child ENT;
- ophthalmology and child ophthalmology;
- general surgery and traumatology;
- oncology.
In these areas of in- and out patient care, the ambulances and clinics are available in accordance with the territorial obligation of the facilities for provision of care, which is based on the residency of the patient (see below).
No referral is needed for the following services either:
- medical follow-ups at dermatology, venereology-, pulmonology- and oncological outpatient centers and curative services, after the first, referral-needed encounter;
- repeated encounters with specialists for medical follow-ups;
- emergency medical care – if immediate medical care is needed.
The need for emergency medical care is determined by a medical specialist. If emergency medical care is not required, the specialist refers the patient to the doctor in charge for further referral and medical examination.
Emergency medical care is available for everyone in any part of the country.
In every other case, second-level medical care is available only with a referral.
Medical services available with a referral
Referring to special medical care is placed by medical order based on the patient’s condition, not by the patient’s choice. In Hungary, every person with social security coverage (insured person) and a referral issued by a primary care physician is eligible for the services of the second level of the healthcare system.
The insured person has to be referred to the proper in- or outpatient facility in the area to which the patient belongs according to their home or place of residency or the premises of the referring physician. Out of area referral is also possible if the physician refers the patient to another facility of the patient’s choice that is out of the area determined by the patient’s residency. In this case, the facility (medical provider) has to confirm the acceptance of the referring physician or the insured person.
Healthcare facilities with a territorial obligation for medical care provision have to provide medical care for those with a referral belonging to their area.
Important! Referrals are only valid in those outpatient centers and outpatient services to which the referral is issued by name. In other healthcare facilities, the referral counts as invalid.
If the healthcare providing facility does not have the necessary conditions to provide appropriate care for the referred patient, the patient needs to be redirected to another healthcare facility with proper conditions and capacity.
Physicians eligible for issuing referrals:
- GPs and GP Pediatricians;
- dentists;
- physicians working at an outpatient department;
- doctors performing same-day surgeries;
- doctors working at psychiatric care facilities and disabled care homes, including physicians working at inpatient facilities;
- school and youth-service physicians;
- doctors working for Homeland Security and army doctors;
- doctors working at correctional institutions;
- doctors working for medical examiner organizations;
- doctors at the chief physician network of the National Health Insurance Fund of Hungary (Nemzeti Egészségbiztosítási Alapkezelő, NEAK);
- physicians working at social care residential institutions;
- doctors at the national sports medicine network;
- doctors of the National Tax and Customs Administration;
- employee-health doctors working at the Ministry of Foreign Affairs and Trade.
Medical services available with specialist-issued referral
Certain special diagnostic procedures and services are only available with referrals issued by specialists. The insured person can be referred to MRI (magnetic resonance imaging), CT (computed tomograpy) and DSA (digital subtraction angiography) examinations by specialists working at in- our outpatient facilities.
Subscription for PET/CT (positron emission tomography/computed tomography) waitlists is accomplished based on the indication (set out in a distinct legislation) of the clinical oncologist, hematologist, neurosurgeon or neurologist specialist working at the in- or outpatient care provider facility.
In particular cases, the insured person can be referred to laboratory tests available within the scope of outpatient services by the specialist working at the in- or outpatient health care facility. Certain laboratory tests can be initiated and performed at a legally determined frequency, except when the patient’s condition requires them otherwise.
If laboratory tests or CT, MRI referrals are necessary in order to continue further investigation of the previously screened and positively tested patient, the doctor entitled to issue a referral can either be the GP, a specialist working at the primary care providing division of the Homeland Security Office or a specialist working at the Homeland Security.
For rehabilitation, the insured person can solely be referred by a specialist entitled to diagnose the underlying disease or treat potential complications of the disease, or a doctor specialized in rehabilitation and physiotherapy.
Children aged 0-3 can be referred to rehabilitation by the GP or the GP Pediatrician, too.
Addicts after the acute withdrawal period can be referred to rehabilitation by a psychiatrist or addictologist specialist or by the GP.
Genetic counseling (within the scope of obstetrics) and the necessary diagnostic tests and infertility tests can be performed upon referral by OB/GYN or urologist specialists.
Out of turn referring order
Out of turn referral can be enlisted in two scenarios:
- In case of disability to work, if the insured person enlists the medical service for diagnostic or therapeutic procedures related to their underlying disease.
- Before transplantation, if the insured person enlists the medical services necessary for subscription and stays on the transplantation waitlist.
The purpose of out of turn referring order is to let the patient regain the ability to work or be subscribed for a transplantation waitlist. However, out of turn medical care is not equal to emergency care.
The doctor in charge of establishing the diagnosis of disability to work can issue an out of turn referral, if:
- the patient has not been seen yet by an outpatient medical provider;
- the patient has been declared to have a disability to work for 15 days, because of the same condition;
- the insured person with a disability to work is eligible for a sick pay based on the disease underlying his or her disability to work;
- the patient enlists the health care system in order to have diagnostic or therapeutic procedures for the disease accounting for their disability to work.
The referral
The referral is an official document that contains essential information necessary for receiving second-level medical care. It is valid until 90 days from issuance.
The prenatal care booklet counts as a referral for the prenatal screening tests involved in the booklet, if it contains the necessary information. The prenatal booklet that meets the above-mentioned criterion is valid until 300 days from issuance.
Territorial obligation for the provision of care referrals might be issued to the in- or outpatient facility corresponding with the patients’ home or place of residency. GP referrals are issued to the health care facility territorially corresponding with the GP’s premises.
If the referral is unclear or information on the patient’s medical condition or on the requested procedures is missing, the health care service can be denied.
For further information on outpatient care, see here.
EESZT
The referral in electronical form (e-Referral) can be issued and forwarded within the EESZT (National eHealth Infrastructure). Citizens can access further information on their valid referrals at the public portal of EESZT, while the referring doctors and the health care facilities can get access to EESZT and information on referrals via their informatic system.
