Since we have no idea what will happen with the family doctors’ lost income from the co-payment, let’s review the current system of paying family doctors. There are about 7,000 family doctors in Hungary who either practice alone or share a practice with one or two others. To establish a practice the family doctor has to have a contract with the local government and with the OEP (National Health Fund). The financing, to my mind, is illogical: these doctors are paid not on the basis of services rendered but simply according to how many patients (of particular age groups) they have. There is a cap to the number of patients who can sign up with Dr. X or Dr. Y. The cap affects doctors in the cities, but is irrelevant in villages where the population has dwindled. Currently there are 134 doctor’s offices where there is no permanent doctor. Another pecularity to my mind is that doctors spend only four hours a day in the office. During the other four hours they allegedly visit patients at home. This might be convenient for some people, but it is an inefficient use of existing resources.
Because these doctors’ monthly "pay" is based solely on their patient population, it is not to their advantage to have sick patients or to perform procedures that they certainly could do (some of them even have specialties) if they can refer the patient on. To give an example. I know a family doctor from the internet; in our discussion group the question of ear cleaning came up. In the U.S. your primary physician cleans your ears, if such a procedure is needed. It’s a simple procedure. You don’t have to be a nose, throat, and ear specialist to perform the job. Yet this particular Hungarian doctor sends his patients to the specialist because, as he said, "nobody pays me for that job." And indeed, from his point of view, he is perfectly right. Perhaps I wouldn’t do it either if I were in his shoes.
During the long negotiations between MSZP and SZDSZ I had inside information that MSZP was planning to change the payment system to one based on services rendered. To help mitigate fraud, the patient would receive a copy of the claim the doctor sent to the insurer. Definitely a step in the right direction. Alas, the idea was dropped. There are new murmurings that the financing of family practices will be put on an entirely new footing. I’m curious what will happen this time.