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.
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.