Part I — Situation overview

On 2 October 2026, two announcements were made at the conference of the Hungarian Association of Pharmaceutical Manufacturers (MAGYOSZ). According to Lívia Ilku, administrative state secretary of the health ministry, the National Institute of Pharmacy will begin operating independently on 1 November. According to Népszava’s report, the proposal on its creation went before the Government twice. The new authority will receive extra funding and staff. Its commitments include speeding up authorisation procedures, increasing the number of clinical trials, improving access to medicines and reducing administrative burdens. It would reach full capacity gradually, by the second half of the third year of the parliamentary term. Zoltán Kaló, director general of the National Health Insurance Fund (NEAK), said that medicines financing would be fundamentally transformed within two years. At its centre is reimbursement, that is, the decision on whether a medicine is included in social insurance subsidies. According to the director general, an amendment to a government decree is already being prepared that would make the background of reimbursement decisions mandatorily public. It would have to be published what health gain the product promises, how many patients it affects, what other treatment is available instead, and how strong the scientific evidence supporting it is. Instead of operating as a “paying office”, NEAK would become a value-based, patient-centred purchaser of services. The director general expects HUF 500 billion of extra health funding a year from 2027, which could add up to some HUF 5,000 billion cumulatively over the four-year term. He added, however, that more money on its own will not make the system better. NEAK’s IT is outdated, some of its servers are decades old, and the institution is struggling with a shortage of experts.

On the same day, according to a Portfolio compilation, some 1.4 million people live in GP districts where care can only be provided by substitute doctors. Nationally more than a thousand practices stand vacant, more than half of GPs are over 60, and the share of those under 40 is barely 7 per cent. The government is preparing a primary care stabilisation package for 2027; the exact figures will be decided in the budget negotiations closing on 15 October. According to a 24.hu article of 3 October, young obstetrician-gynaecologists at the North Buda Szent János Central Hospital have started a pay dispute. According to the doctors speaking to the paper, the hospital pays on-call doctors several hundred thousand forints less in on-call pay than they are entitled to. The hospital management, citing several pieces of legislation, maintains that its practice is in order.

The predecessor of the medicines authority, the National Institute of Pharmacy and Nutrition (OGYÉI), was merged into the National Public Health Centre in 2023; the current step reverses this. In June, when the new head of OGYÉI was appointed, MIAK called for legal autonomy for the professional leadership. On 3 September, in response to NEAK’s plans for outcome-based financing, it proposed risk-adjusted data reporting and adverse-effect monitoring. On 8 September it called for an outcome indicator for the extra health funding. In June it wrote about the János hospital from the perspective of the workforce shortage.

MIAK’s reading: the new element of the announcement is publicity. For the first time, the payer states that the evidence behind a reimbursement decision should be visible to patients and doctors as well. This is the right direction. Whether it becomes a system-wide obligation or an occasional gesture will be decided when the new authority starts. The second risk is capacity: value-based purchasing cannot be pursued on outdated servers and amid a shortage of experts. The third is primary care and on-call duty. These are two faces of the same problem: where the rule for pay is uncertain or subject to bargaining, doctors leave.

Part II — Foundations in the literature

The topic receives its interpretive framework from four sources. According to the volume Health Systems Governance in Europe by Elias Mossialos (professor of health policy at the London School of Economics) and his co-authors, a regulatory agency wins public trust only if it is independent, accountable and transparent. This includes giving reasons for decisions and making dissenting views public. The 2025 synthesis report State of Health in the EU by the European Commission and the OECD shows that, with the application of the EU Health Technology Assessment Regulation from 2025, many member states are strengthening their reimbursement institutions. Health technology assessment (HTA) is the professional analysis of the health gains and costs of new medicines and procedures. Its aim is transparent, evidence-based decision-making. Pablo Gottret and George Schieber, health financing experts at the World Bank, distinguish in their handbook Health Financing Revisited between passive payment and strategic purchasing. According to an analysis they present, merely minimising administrative costs is not a goal, because good purchasing requires analytical work. According to the OECD and European Commission publication Health at a Glance: Europe 2024, the share of GPs among doctors is falling in most countries. The French experience shows that group practices and financial incentives on their own did not solve the problem of medically underserved areas either. Together the four sources say that the success of the reform depends on the transparency of institutions, on measurement capacity and on predictable pay, not only on the amount of money. The detailed discussion of the literature — by author, with quotations — can be found in section 6.4 Literature in detail.

Part III — MIAK’s concrete proposal

MIAK proposes three measurable measures. The first concerns the medicines authority and the publicity of reimbursement, the second NEAK’s measurement capability, and the third on-call pay and GP districts.

3.1 Public reimbursement dossier and quarterly authority performance report (in the government decree amendment being prepared, from 1 January 2027 at the latest)

MIAK proposes that the Government, in the decree amendment being prepared, require a public dossier for every reimbursement application, within 30 days of the decision. The dossier should contain a summary of the medicines authority’s health technology assessment. According to Népszava, the authority previously performed this assessment too, that is, it provided the professional grounds for whether a product could receive social insurance subsidy. It should further contain NEAK’s decision and reasoning, the four announced elements, the expected annual budgetary impact, and whether the reimbursement is conditional and when it will be reviewed. The health gain must be communicated in absolute numbers and in an understandable form: in how many out of a hundred treated patients, and with how many weeks or months of additional survival on average. This is an application of the patient decision programme point E5, and it addresses precisely the director general’s example, where a medicine called “life-saving” offers two weeks of additional survival. NEAK has indicated that in future it will also weigh industrial policy and innovation considerations. The dossier should list these separately from the benefit to the patient, so that it is visible when an economic policy argument decides. The log of consultations with manufacturers should also be included. This is an application of the radical transparency programme point G19 and the lobby register programme point A4. The individual price discount may remain a business secret; the reasoning may not. The new authority should publish quarterly the lead times of authorisation and assessment procedures, the backlog of cases and the number of authorised clinical trials. The first report, covering November 2026 to March 2027, should appear by 30 April 2027. According to Mossialos and his co-authors (see 6.4.1), a regulator’s credibility comes from reasoned, public decisions.

3.2 NEAK capacity plan and pre-set evaluation for every pilot programme (with the 2027 budget, the plan by 31 March 2027)

According to the director general, outcome-based financing will first be tested in pilot programmes, starting with the financing of medicines and technologies. Later it would be extended to primary care and hospitals as well. For this the payer must be able to measure, and today NEAK itself says it lacks the IT and analytical capacity to do so. According to Magyar Nemzet, in the amended recovery plan the envelope for health digitalisation was cut from EUR 250 million to EUR 24 million, so the development must largely be funded from domestic sources. MIAK proposes that within the extra health funding of the 2027 budget a separate, named line should serve the analytical and IT development of NEAK and the medicines authority. It should not get lost among general operating expenditure. NEAK should publish a capacity plan by 31 March 2027. It should include the target for analytical staff numbers, the milestones of IT modernisation and how it connects to the unified electronic health record. This is a direct precondition of the digital healthcare programme point E2. Before each pilot programme starts, the expected result, the baseline value, the comparison group and the date of evaluation, within 12–18 months, must be set down. This is the essence of the ex-post impact assessment programme point G20. The funding of the pilot programmes should be a separate top-up, not an amount taken from base funding, and their results should be published in machine-readable form in line with G1. Gottret and Schieber (see 6.4.3) warn precisely that new payment incentives can have unintended effects, and that strategic purchasing does not work without analytical work.

3.3 Uniform on-call pay rule and public district map (the on-call review within 90 days, the district map from the launch of the stabilisation package)

The János hospital case shows that the calculation of hospital on-call pay today leaves room for differing institutional interpretations. The management cites legislation, while the doctors say they receive less than they are entitled to. The September situation was resolved for the obstetrician-gynaecologists with a partial agreement, an on-call pay supplement, which does not extend to the hospital’s other on-call doctors. MIAK proposes that, on the initiative of the health minister, the method of calculating on-call pay be clarified in the relevant legislation. The maintainer of the state hospitals, the National Directorate General for Hospitals (OKFŐ), should examine within 90 days how on-call pay is accounted for in the institutions it maintains. It should publish the results in aggregate, and where arrears appear, settle them. Pay would thus depend on a rule, not on whether a department’s doctors are able to withdraw from voluntarily undertaken overtime. This extends to doctors the working-conditions and voluntary on-call principle of the retention programme point E6 developed for nurses. In primary care, MIAK proposes a public district map updated monthly: for each district, with the population served, the start date of substitute coverage and the travel time to the nearest surgery. The stabilisation package should set a numerical target for how many people the roughly 1.4 million living in districts covered by substitute doctors should fall by by the end of 2028. This links to the rural public-service minimum programme point TE4, which sets a target of GP access within 20 minutes. The siting criteria of the planned 164 integrated health and social centres are worth showing on the same map. According to the OECD’s French example (see 6.4.4), group practice and financial incentives alone are not enough, which is why it must be measured where they work and where they do not.

The three measures are linked by one principle: extra funding improves care if it is visible in advance what it goes to, and verifiable afterwards what it delivered. The public reimbursement dossier makes medicines spending transparent, the capacity plan measurement, and the uniform on-call rule and the district map the workforce. These three areas will decide whether the HUF 500 billion a year in extra funding delivers results.

Part IV — Expected effects and risks

Dimension Expected effect Risk
Patients Understandable information on what a new therapy offers; the territorial picture of the GP shortage is public Communicating a “small benefit” may cause disappointment among people with serious illnesses if it is not accompanied by a medical explanation
Pharmaceutical industry Predictable reimbursement according to known criteria; measurable authority lead times Manufacturers may contest the contents of the dossier by invoking business secrecy; separating the industrial policy consideration may trigger lobbying pressure
Budget Part of the extra funding goes to measurement capacity, which improves the efficiency of later spending In the short term the named capacity line leaves less for direct care; the evaluation of pilot programmes may be delayed
Institutions The new authority’s performance can be tracked from the first quarter; NEAK’s change of role can be held to account The quarterly report may present the newly launched authority, not yet at full capacity, in a disproportionately bad light
Workforce Uniform calculation of on-call pay reduces institutional disputes and withdrawals from overtime The uniform rule may increase hospitals’ costs; where underpayment has occurred, settling the arrears requires funding

The most important question to weigh is the depth of publicity. If the dossier is only a short summary, the interests of manufacturers and the pressure of patient organisations remain hidden. If, however, every detail is public, manufacturers will be less willing to grant confidential price discounts. MIAK’s proposal therefore calls for full publicity of the evidence and the reasoning, but not of the individual price discount. The proposal becomes risky if the launch of the authority and the decree amendment are not coordinated. If the dossier obligation takes effect only at the end of the transformation, two years from now, the old practice will continue until then.

For the on-call rule, the main question is cost. Uniform calculation entails extra spending in some hospitals, and this must be covered from the sector’s extra funding. According to MIAK, this is not an argument for postponement. If a department’s doctors withdraw from overtime, staffing the on-call rotas is put at risk, which is a direct risk to patient care.

Part V — Measurability and summary

5.1 What is worth following? (suggested KPIs)

MIAK suggests the following key performance indicators (KPIs). These are suggested indicators, not government commitments.

  • The share of new reimbursement decisions accompanied by public reasoning. It is worth setting as a target that, after the decree amendment enters into force, a dossier appears within 30 days for every new decision.
  • The average lead time of authorisation and assessment procedures. Baseline: the medicines authority’s first report, April 2027. It is worth following whether it shortens substantially by the third year of the term.
  • The number of people living in GP districts covered by substitute doctors. Baseline: some 1.4 million people, autumn 2026. It is worth following whether it is on a lasting downward path by the end of 2028.
  • The share of state hospitals in which on-call pay accounting has been reviewed. It is worth setting a full review within 90 days as a target, with a public aggregate.

5.2 Summary

MIAK’s request is addressed to the Government, the health ministry and NEAK. The independent medicines authority and the publicity of reimbursement are a good direction, but they must operate in a mandatory, uniform form from day one. This requires a public reimbursement dossier in the decree amendment being prepared, and named funding in the 2027 budget for NEAK’s measurement capability. A uniform on-call pay calculation and a public, monthly updated GP district map are also needed.

Of MIAK’s foundational values, transparency and data-drivenness are involved here. Transparency, because a reimbursement decision buys health gain with public money, and the patient has the right to know how much. Data-drivenness, because value-based purchasing can only be built on measurement; without measurement capacity the reform remains the same payment, only under a new name.

Part VI — Reasoning and further sources

6.1 Press framing by spectrum

In the left-liberal band, Népszava gave the most detailed report. The paper highlighted that the independence of the medicines authority had been abolished by the Orbán government in 2023, and that Népszava had been the first to write about it at the time. As background, it also explained why the authority’s independence is in the public interest: the European Medicines Agency (EMA) carries out assessments together with experts from national authorities, and at home it was the authority that performed health technology assessment. It noted that NEAK’s first patient representation forum was not open to the press. The paper put the patient perspective and publicity in the foreground, not the financial side. In the public-affairs band, 24.hu appeared on two threads. On the one hand, it presented the medicines financing plans factually. On the other, it presented the pay dispute at the János hospital in a generational frame: according to the article’s headline, the doctors see it as “the change of regime happened so that we would not have to stay silent”. The full article is behind a paywall; the summary is based on the public lead section.

In the economic press, Portfolio framed the reform as a transformation of the entire system, emphasising the medicines market worth several hundred billion forints and cooperation with the EMA. The paper also highlighted that publishing the background of reimbursement could prevent medicines with minimal effect from being presented as “life-saving”. In a separate article, in a “pressure to act” frame, it published a data compilation on the crisis of the GP system. In the conservative band, Magyar Nemzet on this day dealt not with the medicines authority but with the waiting list programme, in a critical tone. It stressed that there are not enough staff for afternoon and weekend operations; in May the minister himself spoke of more than thirty thousand missing nurses. According to the paper, the government cut the envelope for health infrastructure and digitalisation in the recovery plan. This criticism highlights the question of capacity, the same one the NEAK director general raised about his own institution.

6.2 Facts and data

The main figures of the announcements (Népszava, 24.hu, Portfolio, 2 October 2026):

Data Value Source
Launch of the independent medicines authority 1 November 2026 Lívia Ilku, administrative state secretary
Full capacity of the authority by the second half of the third year of the parliamentary term Lívia Ilku (Népszava)
Transformation of medicines financing within two years Zoltán Kaló, NEAK director general
Extra health funding HUF 500 billion a year from 2027; some HUF 5,000 billion cumulatively over the term Zoltán Kaló (Népszava, 24.hu)
Publicity of the reimbursement background a government decree amendment is being prepared Zoltán Kaló

Primary care (Portfolio, 2 October 2026):

Indicator Value
People living in districts covered by substitute doctors some 1.4 million
Vacant GP practices more than 1,000, nearly two and a half times the figure seven years earlier
Share of GPs over 60 more than 50%
Share of GPs under 40 barely 7%
Doctor-patient encounters in primary care some 71 million a year
Growth in emergency department traffic since the new primary care out-of-hours system more than 20% (especially in the capital)
Planned integrated health and social centres 164, each serving 50–70 thousand people
Doctor shortage in some counties (Nógrád, Heves) reaches 30%

Recovery plan, health envelopes (Magyar Nemzet, October 2026): health infrastructure was cut from EUR 643 million to EUR 240 million, health digitalisation from EUR 250 million to EUR 24 million.

Hungarian country profile (European Commission / OECD: State of Health in the EU — Synthesis Report 2025): health spending per capita is EUR 1,925, roughly half the EU average. The share paid out of pocket by patients was 23% of spending in 2023, against an EU average of 16%. Patients pay slightly more than half of pharmacy medicines spending themselves.

A note on the extra funding: MIAK’s analysis of 6 September was about the sector’s extra funding of nearly HUF 500 billion in the revised 2026 budget. The NEAK director general has now spoken of an increase built in annually from 2027. The relationship between the two statements, that is, whether the 2027 amount builds on the 2026 surplus, is not clear from the sources.

6.3 Policy dimensions

  • Healthcare (programme points) — the IT modernisation of NEAK as a precondition of measurement (programme point ID: E2), the publicity of care data (programme point ID: E3), communicating health gain understandably and in absolute numbers (programme point ID: E5), on-call working conditions and retention (programme point ID: E6);
  • Economy (programme points) — outcome-linked planning of the extra funding (programme point ID: G1), public reasoning of reimbursement decisions (programme point ID: G19), pre-set evaluation of pilot programmes (programme point ID: G20);
  • Territorial inequality and rural policy (programme points) — the territorial minimum of GP care (programme point ID: TE4);
  • Transparency and anti-corruption policy (programme points) — the log of consultations with manufacturers (programme point ID: A4);
  • Public administration and e-government (background material) — the organisational structure of the new authority and the measurement of its performance.

6.4 Literature in detail

6.4.1 Elias Mossialos et al.: Health Systems Governance in Europe

The volume’s chapter on EU regulatory agencies examines the operation of the European Medicines Agency and the European Food Safety Authority. According to the authors, to win public trust these organisations must be independent, accountable and transparent. They describe the content of transparency as follows:

“Among other things, this means ‘reason giving’ – making decisions and dissenting views available, delivering timely responses, granting access to documentation and involving stakeholders.”

In other words, transparency means, among other things, giving reasons: making decisions and dissenting views available, responding in good time, granting access to documents and involving stakeholders. Elsewhere the volume recalls that the 1989 EU Transparency Directive already required member states to adopt verifiable criteria for the pricing of medicines and their inclusion in social insurance reimbursement. According to the authors, the influence of governments, the Commission and industry on the agencies may even be too great. Applied to the Hungarian situation: the new medicines authority decides at its launch how credible it will be. The reasoned, public dossier (3.1) is exactly the “reason giving” that the volume regards as a condition of public trust. Listing industrial policy considerations separately addresses the risk of undue influence.

📖 Source: Elias Mossialos, Govin Permanand, Rita Baeten, Tamara K. Hervey (eds.): Health Systems Governance in Europe — The Role of European Union Law and Policy

6.4.2 European Commission and OECD: State of Health in the EU 2025

According to the pharmaceutical policy chapter of the 2025 synthesis report, between 2020 and 2025 member states attempted wide-ranging reforms to improve access and reduce the burden on patients. The EU Health Technology Assessment Regulation (2021/2282) introduces joint clinical assessments from January 2025, and many member states are adapting their national rules and institutions to it:

“To ground coverage and pricing decisions on transparent, evidence-informed processes, many EU countries have reinforced their HTA capacity and governance structures.”

In other words, many EU countries have strengthened their HTA capacity and governance structures so that coverage and pricing decisions rest on a transparent, evidence-informed process. As an example it mentions the quality agency set up by Slovenia in July 2025. The report also names Hungary: here, early access schemes already allow certain therapies to be used before the assessment is completed. In Hungary, cost-effective medicine choices are also linked to prescribing feedback and incentives. According to the Hungarian country profile, patients pay slightly more than half of pharmacy medicines spending. The establishment of an independent authority is thus part of a European trend. And the public dossier (3.1) can make the results of the EU joint assessment visible together with the domestic decision.

📖 Source: European Commission / OECD / European Observatory: State of Health in the EU — Synthesis Report 2025: Health Policy Reform Trends in the EU

6.4.3 Pablo Gottret and George Schieber: Health Financing Revisited

The World Bank handbook distinguishes three functions of health financing: revenue collection, risk pooling and purchasing. According to the authors, the WHO identified strategic purchasing as a central element of health system performance. Yet in many countries passive, simple retrospective payment dominates, and the transition is slow and uneven. According to the volume, strategic purchasing and new provider payment incentives have somewhat improved efficiency, but have also had unintended consequences. Strict capitation, for example, led to a decline in preventive care, while case-based payment encouraged inflating the number of cases. Presenting Joseph Kutzin’s analysis, the authors also state:

“Kutzin’s analysis also highlights the importance of active purchasing, indicating that it is not desirable to simply minimize administrative costs.”

In other words, active purchasing matters, and simply striving to minimise administrative costs is not desirable. Turning NEAK from a “paying office” into a purchaser is precisely the transition from passive to strategic purchasing. According to the volume, this has a price: analytical work, data and IT. The named capacity line under 3.2 makes this price visible. The pre-set evaluation serves the early detection of unintended effects.

📖 Source: Pablo Gottret, George Schieber (World Bank): Health Financing Revisited — A Practitioner’s Guide

6.4.4 OECD and European Commission: Health at a Glance: Europe 2024

According to the OECD publication, in most countries the main concern regarding doctor shortages is the shortage of GPs, especially in rural areas. On the EU average in 2022, only about one fifth of doctors were GPs and two thirds were specialists. It presents the French example in detail:

“However, despite these efforts and the provision of various financial incentives for doctors to set up their practices in underserved areas, the measures do not seem to have been sufficient to resolve the issue.”

In other words, in France the problem was not solved despite multi-professional health centres and financial incentives for doctors settling in underserved areas. According to the publication, 2,500 such health centres were operating by the end of 2023, with a target of 4,000 by the end of 2027. On Hungarian doctors’ pay, the volume records that the new medical service contract of 2021–2023 brought a 120 per cent increase over three years. It also notes that overtime pay is left out of income data in several countries. The Hungarian lesson is twofold. The planned 164 integrated centres and the incentives of the stabilisation package are instruments similar to the French health centres, so the district map (3.3) should measure where they work. Alongside raising base pay, the predictability of on-call pay is a separate question that pay statistics do not show either.

📖 Source: OECD / European Commission: Health at a Glance: Europe 2024

6.5 International comparison

The publicity of reimbursement decisions is established practice in several European countries. In the United Kingdom, the technology appraisal guidance of NICE (National Institute for Health and Care Excellence) and the committee documents preparing the decision are public. In Germany, the independent Institute for Quality and Efficiency in Health Care (IQWiG) publishes a public benefit assessment of the evaluations submitted by the manufacturer before the price is negotiated. According to the 2025 State of Health in the EU report, Slovenia created a separate agency in 2025 to implement the EU HTA Regulation. Lithuania set a statutory deadline for pricing and reimbursement decisions, although compliance with it is proving difficult. In Estonia, from 2025 a new national assessment guideline requires reimbursement decisions to be based on clinical and economic evaluation. In primary care, according to the OECD, France tried to tackle medically underserved areas with group practices and incentives, with partial success. The common element: an authority’s credibility comes from reasoned, timely and public decisions. In Hungary, the establishment of an independent authority provides an opportunity for this.

Healthcare

  • E2 — Digital healthcare system
  • E3 — Waiting-list transparency
  • E5 — Patient decision support
  • E6 — Nurse retention package

Economy

  • G1 — Data-driven budget
  • G19 — Radical transparency in economic decision-making
  • G20 — Economic policy impact assessment system (Drucker audit)

Territorial inequality and rural policy

  • TE4 — Rural public-service minimum

Transparency and anti-corruption policy

  • A4 — Lobby register

Proposed new programme point: Public reimbursement dossier and quarterly medicines authority performance report — for the Healthcare area.

6.7 List of sources

Press sources (MIAK press monitor, 3 October 2026 — topic 2):

Knowledge base references (books):

  • 📖 Elias Mossialos, Govin Permanand, Rita Baeten, Tamara K. Hervey (eds.): Health Systems Governance in Europe — The Role of European Union Law and Policy
  • 📖 European Commission / OECD / European Observatory: State of Health in the EU — Synthesis Report 2025: Health Policy Reform Trends in the EU
  • 📖 Pablo Gottret, George Schieber (World Bank): Health Financing Revisited — A Practitioner’s Guide
  • 📖 OECD / European Commission: Health at a Glance: Europe 2024

MIAK internal materials:

Supplementary public data sources:

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