How to make sure that no doctors will remain in Hungary?

The Hungarian government is in the process of launching a new healthcare reform. Pardon me, I almost forgot, the word “reform” is banned. In its place we should use “structural reconstruction,” “fine tuning,” or simply “implementations.” As usual, this latest “fine tuning” was not discussed with any of the people it will affect, the healthcare professionals.

As I was looking through my rather extensive database of Hungarian political news, I discovered that I already had a category called “healthcare reform.” That was in 2010-2011. The man who was supposed to reform the healthcare system then was Miklós Szócska, who came from academe. He was an associate professor and deputy director of the Healthcare Management Center at the Semmelweis Medical School. His curriculum vitae was impeccable: he had studied in the Netherlands, Japan, and Great Britain and spent a year at Harvard University. At the time he was perhaps the only member of the Orbán government who looked and acted like a gentleman. People who knew him had high hopes that Szócska would be able to perform miracles. Well, he didn’t. In his last days on the job the only thing he could say about his record was that in the past twenty years he was the first man to last four years in this position. All the others either quit or were dismissed.

Throughout the spring of 2014 there was a daily drumbeat of reports about Viktor Orbán’s dissatisfaction with the state of the Hungarian healthcare system. The government had nationalized all the hospitals, hoping to decrease costs, but year after year practically all Hungarian hospitals accumulated huge debts that had to be paid, at least in part, from the central budget. Currently at least three hospitals are in bankruptcy proceedings. Meanwhile, the quality of care has decreased and the number of doctors and nurses seeking employment abroad has been growing.

Szócska’s replacement was Gábor Zombor. By training he is a physician, but after a short stint as a practicing doctor he became a full-time politician, serving as mayor of Kecskemét and a member of parliament. We know that Viktor Orbán wanted to have a politician in this post, and Zombor’s performance in Kecskemét was promising. It was during his tenure as mayor that the Mercedes-Benz plant was built. He cooperated with both the socialist-liberal governments and German businessmen to bring this factory to the city.

Zombor became undersecretary in charge of healthcare in June 2014. Soon after his appointment he announced that he wants to get rid of the cancer of Hungarian healthcare, the so-called “gratuity” (hálapénz). Over the years there have been some timid steps taken in this direction, but nobody has dared to forbid and criminalize the practice. Now it seems that Zombor has a new plan. The government will raise doctors’ salaries by 100,000-200,000 HUF ($373-$746) but only if they sign an agreement that they will not accept any “gratuity” and will not emigrate. Judging from the initial reaction, this idea is dead in the water.

Gábor Zombor annnouncing his plans at a press conference

Gábor Zombor annnouncing his plan at a press conference

Today the Hungarian Medical Association officially announced that they are ready to cooperate with the government, but the association’s press release makes it clear that they are ready to negotiate with the government about a raise, long overdue, but without any strings attached. The Association of Hungarian Residents, which managed to get a pay raise for young doctors straight out of medical school a couple of years ago and agreed to a limited “ban” on emigration, today finds it unacceptable to forbid the free movement of specialists. The Association of Hungarian Residents figured out that, to come out even, specialists’ salaries would have to be tripled if they are forbidden to accept extra money under the table from their patients.

What is the Hungarian government up against? There are several rankings of physician salaries by country. Although there are slight differences depending on the methodology of calculations, all agree that doctors do best in the United States, Australia, the Netherlands, Belgium, Canada, United Kingdom, France, Ireland, Switzerland, Denmark, Germany, Norway, Sweden, etc. I found only one chart that also shows Hungary’s pay scale. Here, Hungary is the practically at the bottom of the list, just ahead of Mexico. In 2012 the average salary of physicians in Hungary was 203,189 HUF, less than the national average of all employee salaries. That would be $756 a month, but a doctor’s actual paycheck is, according to a handy internet calculator, only 131,000 HUF, or $484.

So, let’s compare salaries in the United Kingdom where most Hungarian doctors migrate. According to the most recent official information coming from the National Health Service, a young doctor in training earns a basic salary is £22,636 or $35,147 in his first year of employment. This is about four times the average Hungarian gross salary. Even if we take into consideration the difference in purchasing power, the pay gap is so enormous that the Hungarian government couldn’t possibly stop the exodus of doctors unless it forbade freedom of movement. More seasoned specialists make between £37,176 and £69,325 a year. I really wonder whether the government officials responsible for this latest brainstorm ever looked at the pay scales of physicians in other countries, especially since it is a well-known fact that there are shortages of doctors in many countries–Great Britain and Sweden, for example.

If the government is serious about making the acceptance of under-the-table gratuities a crime, I’m sure that the emigration of Hungarian physicians will double. Only those who are too old and those who speak no language other than Hungarian will remain. This is certainly not the way to go. A few more “reforms” like this and the whole Hungarian healthcare system will collapse.

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Ron
Guest

For members of sport clubs, who want to compete, even amateurs and/or young ones (age 7 and higher) there is the requirement of the sport doctor examination every half year:

It comprise of an EKG and analysis of urine as well as the visit to the sport doctor. As of February 1, 2015 the government added the requirement of an eye examination as well as an orthopedic specialist approval. the approval for these doctors is valid for 2 years.

The Sport doctor was always an hassle, you have to make an appointment at least 2 months in advance, although some areas it is one month. As I understand in Budapest it is centralized now in the sport hospital.

The area where I live there are no eye doctors or orthopedic specialists, according to a nurse they try to find them, but there are none or they do not want to work for a small salary.

In Budapest some sport clubs arranged these doctors to come over, and for a fee of HUF 3,000 to 4,000 they sign the papers, I learned that these guys make about HUF 1 million per year only on these fees per club.

Live long and prosper
Guest

Yes, I’ve experience of this with 2 sons on school. I think it’s an absolutely ridiculous waste of time and money.

Member

Isn’t it illegal in the EU for any country to forbid by law for a citizen to move to any of the member states?
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If by any chance, the proposal becomes a law, and I were a doctor, I would sign it, pick up the extra salary, keep receiving the gratuity only when offered by trustworthy patients in a form of personal gifts outside the workplace and leave for a job, when found or offered abroad. Hurt the illiberal every place and all the time, when there is a chance.
————-
The purpose of Fidesz/KDNP/Jobbik is to do away ALL social benefits, including healthcare. They want to collect taxes, buy businesses, keep the money and never give a penny to any of the taxpaying citizens. There is no Hungarian Constitution since 2011. However, the New Hungarian Collusion (Tákolmány) allows the Government to spend tax moneys without disclosing its purpose and amounts..

Ron
Guest

gybognarjr: “Isn’t it illegal in the EU for any country to forbid by law for a citizen to move to any of the member states?”. Yes it is illegal in the EU. However, VO will find a way. a few years ago, he made students to sign a contract to do work in Hungary, after completion of their studies. If believe student have to work 5 to 10 years for a small salary to repay their education costs. It was perfectly legal. Unethical, but legal.

Awgart Rawetrwetr
Guest

Unethical? Why? Because he studied free in the university for many years from the Hungarian taxpayers money? Have the Hungarian taxpayers to support the richer foreign countries with doctors who studied from Hungarian money?

Member

The EU is giving billions of Euros to Hungary, while Orban and his buddies are marching and protesting against the EU. The reason Orban could provide free education because he was able to use the EU’s money. Now, he even stopped providing free education, so your comment does not reflects the truth. When the EU stops giving money to Hungary, then Orban can start dancing to his own drum.

Awgart Rawetrwetr
Guest

Between the years of 1996-2000 were the best economic situation in Hungary It was long before 2004. Since Hungary joined to the EU, all sectors of the Hungarian economy became much weaker.

Awgart Rawetrwetr
Guest

It was the ONLY good decision during this 5 years of Fidesz rule.

Member

No. This was part of many of those decisions that would make people serve Orban by contributing from their underpaid jobs with their taxes to build stadiums, by pianos, and castles for Orban and his gang. Orban’s job (what he gets paid very well for) is to create a country that people want to stay in.

David
Guest

UK salary of 37k – 69k is per year, not per month.

Ron
Guest

The website 444.hu had published some names working in a Bristol Hospital in 2013

http://444.hu/2013/11/21/hogy-kik-dolgoznak-egy-bristoli-korhazban/

From time to time I noticed some names on facebook as well. Brsitol, Birmingham and London seems to be the place to be for these doctors and veterinarians as well.

Wondercat
Guest

“More seasoned specialists make between £37,176 and £69,325 a month.” — As a consultant physician at a London hospital, I have to disagree: Perhaps that much in a year; and netto rather than brutto.

Ron
Guest

Totally OT: It seems that Simicska did not changed his mind. Some reporters from the TV program Celpont resigned and posted a video saying VO is not a prick. Simicska’s response is VO is a prick and Zsolt Bayer is a bitch.

http://www.hir24.hu/belfold/2015/02/25/simicska-reagalt-a-hir-tv-sek-felmondo-videojara/

The aforementioned should be hilarious, unfortunately, that such highly qualified, educated people have some kind of blockage in their system. Can they not see what is going on?

Live long and prosper
Guest

SL’s quotes are hilarious. He’s on a par with Michael O’Leary, boss of Ryannair.

petofi
Guest

“Prick” doesn’t quite do the trick as an accurate translation for ‘geci’…It’s the kind of word
one would hear among the drunkards of a dingy, mid-afternoon tavern of the meagerly employed.

But I’ll bet the short video went viral among teenagers, and what a lesson it sent out!
“If you want a job in today’s Hungary, you don’t need to send out CVs or attempt to stand
on your merits….just send a fawning tribute to the Felcsutian, and your future is made.”
Disgusting.
But then, Hungary’s is a disgusting society…

ambator
Guest

Perhaps, they do see what is going on, but want to err on the safer side and believe Orban’s to be it. However, I believe, they underestimate Simicska. He is an unusually clever bastard, better read, better practiced and much better strategist than anyone in the government, including Orban. I am watching with glee as this bunch of cheap opportunists are all loosing their bearings and are grasping desperately for for some brass ring to hold onto.
Because this is the case, Simicska surely knows that the revenge is best when served chilled. He is also aware, I am sure, that in the wrestling mach of politician vs. the press the politician is bound to loose, (just remember Richard Trickydick Nixon!), if for no other reason then because the politicians’ terms are limited but the press goes on damaging them.
If Simicska is as persistent as he is resourceful, Orban is toast.

Member

My apologies but I’ve seen “geci” prick being translated as “prick” over and over, and it is not “prick”. Warning of explicit language! Geci means “cum”. Please those who speak Hungarian and English look it up.

Guest

Well, my German/Hungarian dictionary of slang has as second meaning (besides cum) for geci:
Scheißkerl which is similar to prick but much stronger .like “a nasty piece of work”, comparable to a**hole combined with some other expletive.

Live long and prosper
Guest

FYI – I go private in Hungary, with medical insurance. But I think the price my insurers pay is outrageous: 62,000 HUF for a basic (eg 15 minute) consultation with a GP. (I’m looking for a new healthcare provider, if anyone can recmend one.)

Ron
Guest
I had a similar situation. I enter into a contract with the Hungarian healthcare insurance (TB), obtained a TB card and pay each month HUF 6,930 (see below). However, there are requirements such as: to have a tax number, residential permit and/or working permit, a lakcim card Then go to the TB office (next to the National Police station). http://www.nav.gov.hu/nav/regiok/kozep_dunantul/kozepdunantul/ugyfelszolgalatok/segitjarulekfizetesikotelezettseg.html Google translation Health service contribution liability (Legal background: the beneficiaries of social security and private pension and the Law on the coverage of these services in 1997 LXXX (Social Security Act), § 5, § 16, § 39 of the Act LXXXIII on compulsory health insurance for 1997… § 20 of the Act XCII of § 29 (9) of the Tax Code of 2003 (6) -. (7), (7), (7c) (10)) and the In Hungary, the social insurance is a risk community, which required the participation of all, and that the participation and liability basis for entitlement to certain benefits. Consequently, the liability shall be met even if the health service at all is used. When bound to pay the private health service contribution? The health service to pay contributions to a private individual who is the Social Security Act. it is… Read more »
googly
Guest

If a Hungarian healthcare worker speaks English well enough to work in Britain, then that person is much better off moving to the U.S., where he or she can earn a lot more money. It’s certainly more difficult to get a visa, but I understand that it’s very likely that an experienced healthcare worker will be able to get a work permit, since there seems to be a perpetual shortage of almost all such people.

http://www.healthcare-salaries.com/physicians/medical-doctor-salary-md

It’s actually kind of shocking how much even the lowest-paid physician earns!

After only a few years of work, a physician can return to Hungary and retire, or work only part-time to keep from being bored. Plus, he or she will have more experience.

Miki
Guest

@Googly

I would do exactly the same. It may be a hassle, but if you see how much doctors work in Hungary to get a proper income getting a visa is an easy job.
Many doctors have 2 jobs and really work day and night.
The salaries of the doctors are that low that it’s not easy to understand why anybody would like to be a doctor in Hungary. Of course for this Fidesz is not only to blame, because it has been always like this.
The hálapénz is something that should end, because we are not talking about small amounts here. If you would like to receive normal care in a hospital you are not only supposed to pay the doctor(s) but the nurses and anybody else involved as well. Poorer families have to spend their savings on this.
The only way to do this is of course giving them a proper salary of around 1 mln HUF.

Member

In the USA and in Canada if you want to work as a medical service provider and you earned your degree in Hungary you have to go back to school. It is not automatic transition, as they have different requirements. I do meet some dentists, general partitioners from Hungary who had to do this.

tappanch
Guest

FYI:

The result of four and a half years of Fidesz rule, 2014-12-31 vs 2009-12-31

Change of the net debt of the central government: +59.35%
Change of the net debt of the total (central+local+soc.sec.) government: +51.52%

These official numbers include 2,854.5 (later 2,851.0) billion forints of nationalized (in 2011) private retirement funds since 2014-06-30.

tappanch
Guest

Of course, the increase of the debt would have been much higher without the yearly 4 to 6 billion euros from the European Union.

So the net debt has been increasing at a yearly rate of 9.8% in the last 5 years, even with European support, but the yearly deficit has been below 3% . This is a joke, but the consequences will be tragic when it bursts!

tappanch
Guest

Another strange thing waiting for an explanation from an insider:

The foreign reserves of the National Bank (MNB) were supposed to go down by 9 billion euros because of the conversion of the Swiss franc dominated mortgages, but instead, the reserves went up by 3.6 billion euros. Where did the 11 to 13 billion dollar difference come from (EU support, Russian money, newly issued bonds?)

MNB reserves in billions of euros:

2014-10-31: 34,218.4
2014-11-30: 34,134.7
2014-12-31: 34,578.3
2015-01-31: 38,229.9

csabai
Guest

I always wondered why people (investors, independent observers, bureaucrats etc.) readily assume that the published statistics are true when otherwise the government and its leaders, friends etc. are constantly lying and manipulating the public (ie. they are manifestly thoroughly corrupt).

Greek is an obvious example: nobody realized in Brussels for years (even though dozens of auditors and statisticians and experts reviewed the figures, besides investment bank, investors etc.) and nobody would have, if Greece wouldn’t have been close to default.

MNB *is* cooking its books.

Moreover the central bank is currently spending HUF 200bn on fun issues, including but not limited to acquiring rural real estate from friends, establishing private foundations, buying violins and artifacts.

Most recently the central bank is planning to open several representative offices including one in Beirut and one in Buenos Aires (!), probably learn from countries which have recently defaulted.

tappanch
Guest

Correction: Reserves in millions (not billions) of euros, naturally.

Guest

Maybe I shouldn’t write this:
In most smaller towns and villages in Germany (and probably other EU countries as well) there is a real shortage of “Praktische Ärzte” i e family doctors, the German authorities are trying everything, from advertising to cheap loans to open/take over a practice in the country.
Any (Hungarian, Romanian, Egyptian, Syrian – yes we have quite a few of them!) physician with some knowledge of German might come over maybe as an assistant to a family doctor in a small town. They often are very old and want to retire – paying a Hungarian assistant a good wage would not be a problem.
And after some time he/she could take over the old doctor’s practice – everybody (except the home country of course) would be happy!

PS:
Though I know that Hungarian wages are low I was shocked at Eva’s numbers, especially this:

In 2012 the average salary of physicians in Hungary was 203,189 HUF, less than the national average of all employee salaries.

Unbelievable!

petofi
Guest

@csabai

Quite right: people are naive to trust this government’s statistics.

The funniest thing I heard in a long time was, back a couple of years ago when the Greek problem first emerged,….Orban popping up like a jack-in-the-box and declaring that Hungary had a similar shortfall! Ain’t the Felcsutian cute?

Orban and his minions have been found so often, so short, of the truth, that it means nothing to them to lie. Whatever works, I guess. When caught out, they claim that they have been misunderstood, and attempt to explain away what was said before. New lies; always new lies.
What an absolutely disgusting government.
But how disgusting the society that tolerates such a government!!

tappanch
Guest

The new head of the Hungarian Calvinist Church is a friend and former classmate of Orban’s minister of “human resource”, Z Balog.

http://nepszava.hu/cikk/1049481-tisztujitas-a-reformatus-zsinatban

dora
Guest

Don’t worry about doctors leaving Hungary.

They are already being replaced by people from Egypt, Saudi Arabia, and Sudan.

So much for all that talk recently about how immigrants from all those “other places” are unwelcome here.

Give the “unwanted immigrants” another 25 years, and they’ll be running Hungarian healthcare!

Our local hospital is full of them. And let me tell you, they do a great job. They are more respectful toward the patient than the “Hungarian” doctors are.

Also … the doctor shortage could easily be solved by one quick piece of legislation granting wider-ranging powers to highly experienced nurses.

I’m thinking of the US. They have Physician’s Assistants and certain highly-qualified nurses essentially doing what GPs do.

And regarding what previous commenters said about their children’s sports physical exams…

…last summer I renewed my driver’s licence. I am 35 years old, and in perfect health. Nevertheless I had to go to my GP and obtain a certificate stating that I was in perfect health. I paid my GP 7000 HUF for this.

Good business for him!

But I understand that this sort of thing is not done in other countries. If your licence expires, you just go renew it, your local GP profits nothing from it.

tappanch
Guest

1. Fidesz will rededicate a remake of the Horthy era’s “resigned white Kossuth” sculpture in front of the Parliament on March 3. The “fighting red Kossuth” of the post-ww2 era was removed a year ago. (was it also destroyed? who knows about it?)

2. It took 2 months for the government to spend 6 months of special reserves in the budget

3. 70% of the 100 billion of “disappeared” money is missing from the four banks and the rest from the brokerage “Buda-cash”

http://www.napi.hu/tozsdek-piacok/onfeljelentes_inditotta_el_a_buda-cash_botranyat.594116.html

4. Another company of the former (till 2015) head of the Treasury Töröcskei went bankrupt.
This will affect Simicska “la foutre” negatively in his assets.

http://www.napi.hu/magyar_vallalatok/ujabb_torocskei-ceget_szamolnak_fel_simicska_is_rosszul_jarhat.594118.html

5. Last, but not least:

The text of the Paks-2 treaty is unlawful.

So the Orban government plans to use the usual tool: a new, retroactive law to make it lawful “ex post facto”.

http://www.napi.hu/magyar_vallalatok/ujabb_milliardok_mennek_paksra_titokban.593939.html

They also want to make the Paks data and contracts a state secret for 15 years.

Member

Wouldn’t they need 2/3? I am afraid this will be the instance when they will hug Jobbik and vote together to sell Hungary to the Russians.

tappanch
Guest

The Hungarian text of US-Hungary social security totalization bill:

http://www.parlament.hu/irom40/03484/03484.pdf

Istvan
Guest

Eva the Carnegie Endowment for International Peace picked up your post about the election results in Veszprem and did a post citing you, see http://carnegieeurope.eu/strategiceurope/?fa=59190 An Orban supporter also took the time on the blog associated with that site to attack you as an “unabashed pathological Orban/Fidesz hater.” I think that is really a bit of an honor.

But here is the interesting thing, the poster of that comment used the alias “Jeff Davis.” Of course Jeff Davis, short for Jefferson Davis was the one and only president of the southern Confederacy in the US Civil War who authored a memoir entitled “The Rise and Fall of the Confederate Government,” defending human slavery as just and the southern succession from the USA as a legitimate protection of property rights and freedom for the slave owners. Ideologically that raised the thought of the type of people attracted to Orban and his crew.

Guest

All this explains, that whenever I have gotten sick during my visits, my hosts NEVER suggested a doctor. Simply ignored my questions. Come to think about it, the only family doctor/hospital visits I’ve heard of have been of a surgical or heart-attack nature–nothing less than the most serious.

Paul
Guest

The hálapénz in perspective:

The Hungarian side of our family is full of doctors – surgeons and specialists, though, no GPs. And each and every one of them lives a luxurious life – big house, dacha at Balaton, two or more new cars, two or more foreign holidays a year.

This lifestyle simply isn’t possible on their official salary, or even twice that amount.

They are all solid Fidesz supporters, to a man and woman, but the chances of them giving up the hálapénz are zero.

Incidentally, even if the government did manage to abolish the ‘brown envelopes’, it wouldn’t necessarily solve the problem, as a lot of the ‘thanks’ comes in non-monetary forms – e.g. gifts of food or services.

Paul
Guest

Re salary comparisons:

Before retirement, I was on a salary which these days would be easily within the band Éva gives for “more seasoned specialists”, and there’s no way I could afford my in-laws’ lifestyles on that sort of money.

That salary bought a three-bedroomed ‘semi’ on the outskirts of a county-town, well outside the commuter belt, a newish second-hand car, and a fairly comfortable life-style. But we couldn’t afford family holidays until my wife went back to work, and there’s no way we could have lived in London on that sort of income.

I have no real idea what sort of salary would be needed for my in-laws’ life-style in the UK, but I would guess it would be considerably over £100,000 (€140,00, $155,000).

One last point – Éva’s figures are a little misleading, as most surgeons, specialists, etc in the UK also do private work, which pays considerably better – in fact some are effectively private doctors who do a few hours a week in the NHS!

tappanch
Guest

Last minute Fidesz amendment to the Paks-2 bill:

Everything will be hidden in the secret vault for 30 years, not 15 !

http://www.origo.hu/itthon/20150226-15-helyett-30-evre-titkositanak-paksot.html

(I hope a new government will simply undo this)

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