The doctors and health reform

A new opinion poll was published today that gives insight into the thinking of approximately 40,000 Hungarian doctors about the health care reforms still under way. This is the first solid indication of what we all suspected: most of the doctors’ political views lean toward the right. Most of them reject the reforms, although they admit that the reconstitution of Hungarian health care is necessary.

If one looks at answers to questions about specific aspects of the changes one might think that the doctors are actually supporting the reforms. They agree, for example, that the non-paying freeloaders must be eliminated, most of them agree that certain surgical procedures do not require a hospital stay, they think that certain hospitals should offer specialized services, they also think that perhaps it would be fair to establish a first come, first served principle to schedule surgical procedures because even they realize that "gratuity" can decide who will be operated on tomorrow and who in three months.  There were sixteen questions all told, and out of these sixteen in only four cases did the majority say that the reforms were harmful or not beneficial. These were: changing membership in the Medical Association from compulsory to voluntary, introducing a minimal fee for certain drugs, closing certain hospitals, and prescribing generic drugs unless the patient insists on non-generic.

But when it came to questions concerning the general scope of the reforms, the opinions were less favorable. Only 10% of them said that they more or less support the reforms, 22% said that they are somewhat against the reforms, and 23% are outright against them. The main reason for the rejection is undoubtedly job or income insecurity. It is one thing to accept the reforms in theory and another to feel the possible negative effects of these reforms on their own lives. Eighty-five percent of physicians working in hospitals claimed that some jobs were lost as a result of the reforms and only 39 percent of all doctors could report improvements.

It is hard to judge the accuracy of these reports about the situation in the hospitals or in the offices of primary physicians because, when they were asked about their income, almost half of them claimed that in the last year their incomes were significantly lower than before: 16% less. Moreover one-third of those asked refused to answer any questions concerning their income. Of those who answered, only half claimed that they ever received any "gratuity." As usual, the givers and the receivers remember differently about the sum of these "tips."  Those who admitted receiving a "gratuity" claimed that the monthly sum was, on average, 46,000 ft. That would be about 11 billion forints nationwide. Patients remember (in another poll done by the same polling company) more than the double this amount: 28 billion forints. The doctors claim that since the introduction of co-payment their income from "gratuity" has fallen by 40 percent (which, of course, again may or may not be accurate). One interesting footnote: the majority of the doctors, just as the majority of the population, think that "the gratuity is unfair, but one must live with it because one cannot put a stop to the practice."

Of course, their financial situation influences the doctors’ opinions. The family physicians and doctors who work with special contracts feel that their situation is better now than before, mostly because of the introduction of co-payment. Within the hospitals the doctors in higher positions complain most because they claim that the reforms have already negatively affected their incomes. The young doctors in theory support the reforms but are afraid that they will be the first ones to lose their jobs if someone is let go from the staff.

However, it seems that money is not everything and here comes the question of political commitment. Even the family physicians who benefit from the co-payment would vote "no" on a possible referendum on the question. Here they follow their favorite party’s lead. After all, the Fidesz initiated the referendum on this and other health-related questions. Perhaps it is unfair to say that the Hungarian doctors’ resistance to the reforms depends on their political leanings, but one thing is sure: according to the poll, three-quarters of them would vote for the Fidesz or one of the other opposition parties at this moment. I might add to this that the Hungarian medical profession was always very conservative. My hunch is that even if the reforms have beneficial effects in the next three years, they will still vote for right-wing parties.