I often start my posts with a reference to the incredible number of articles that appeared in the Hungarian media on the topic of my choice for the day. Well, this time I was met with deafening silence when I tried to locate material on the findings of the EuroHope (European Health-care Outcomes, Performance, and Efficiency) project that compared, over three years, the quality and cost of hospital care in Finland, Hungary, the Netherlands, Norway, Scotland, Sweden, and certain provinces in Italy. The researchers focused on care for five medical conditions–heart attacks, strokes, hip fractures, very premature infants, and certain forms of breast cancer. Of the seven countries, “Hungary fared worst for most health outcomes, largely due to economic factors,” as reported by The Lancet.
The findings of EuroHope were released more than a year ago, on April 4, 2014. A detailed ranking of the countries by type of illness has been available on the website of EuroHope for at least a year, but for some strange reason the devastating news about the state of Hungarian hospital care didn’t reach Hungary until now.
To demonstrate how grave the situation is in Hungary in comparison to the other six countries, let me quote from the abstract of an article by A. Malmivaara et al. that appeared in February in the European Journal of Neurology.
In all, 64,170 patients with a disease code for ischaemic stroke were identified. The number of patients registered per 100,000 European standard population ranged from 77 in Scotland to 407 in Hungary. Large differences were observed in medication use. The age- and sex-adjusted all-cause case fatality amongst hospitalized patients at 1 year from stroke was highest in Hungary at 31.0% (95% confidence interval 30.5-31.5). Regional differences in age- and sex-adjusted 1-year case fatality within countries were largest in Hungary (range 23.6%-37.6%) and smallest in the Netherlands (20.5%-27.3%).
I find it curious that for more than a year one could learn nothing about these devastating results in the Hungarian media. Moreover, when on June 28, 2015 Válasz came out with an article titled “Little money, great death: the end of a Hungarian legend,” nobody felt compelled to pick up the story. Naturally, the government wasn’t going to rush to comment, but even MSZP, LMP, Együtt, and PM acted as if they had never heard of the findings of EuroHope. It was only DK’s medical expert, former hospital director Imre László, who bothered to send his party’s reaction to MTI, in which he claimed not only that the money allocated to heath care is inadequate but that it is badly spent.
What legend was Válasz referring to? The Hungarian medical profession claims that, although not enough money is spent on health care, Hungarian doctors are well prepared, which makes up for the material deficiencies. Válasz countered that if that were the case, there wouldn’t be such a huge difference in the numbers of Scottish and Hungarian stroke patients.
The Hungarian statistics are no better when it comes to heart attacks, which Válasz calls tragic. In Hungary 18% of the patients die within 30 days after a heart attack, while in Scotland it is 12% and in Norway only 6%. So, if you are unlucky enough to live in Hungary, your chances of dying shortly after a heart attack is three times greater than if you lived in Norway.
In brief, Hungary was dead last when it came to the mortality rates of stroke and heart attack victims and next to last in the other three categories: hip fractures, very premature infants, and certain forms of breast cancer. Nothing to brag about.
It didn’t take long for the Hungarian medical profession and even the government to respond, although the government made no public statement. Instead, the undersecretary’s office sent a letter to the editors of Válasz in which they outlined all the plans the ministry has prepared to remedy the situation. Péter Ofner, directior general of the György Gottsegen, Országos Kardiológiai Intézet, went public. He held an extraordinary press conference and released a statement in which he and his colleagues basically argued that EuroHope’s numbers are outdated. According to a statement at the 2013 Congress of the European Society of Cardiology, the difference between the Swedish and Hungarian statistics is small, 7.9% v. 9.5%, and even that can be explained away by the fact that Hungarian patients also suffered from other diseases in addition to their heart attack. So, no matter what EuroHope says, Hungarian medical care matches the best in Europe by now.
Tibor Ertl, an expert in neonatology, explained some of the reasons for the poor showing, among them the “societal roots” of the high number of premature babies, an insufficient number of nurses, hospitals not following strict rules, and of course the shortage of funds.
In addition to this lone article in Válasz, I heard an interview with Jenő Rácz, former minister of health in the Medgyessy government. Despite having been a member of the socialist-liberal government, his public appearances since he left office leave no doubt that Rácz’s sympathies lie with Fidesz.
Rácz, like his cardiologist colleagues, refused to admit that the poor performance of the Hungarian medical profession had anything to do with a lack of funds or professional competence. He didn’t deny the veracity of the statistics, but he attributed the poor results to an unfair comparison. To compare Hungary to highly developed, rich countries like Sweden, Norway, and Finland is simply not fair. Rácz didn’t mention Scotland, and he disregarded the fact that the goal of the research was to find out to what extent the amount of money spent on health care influences outcomes. He also stressed that the data is from 2008 and 2009 and since the government has spent a great deal of money to improve the situation.
Rácz’s other argument was that the Hungarian population is a great deal sicker than the populations of the other nations in this study, and therefore any comparison is inherently misleading. One physician after the other claims that patients are largely responsible for this state of affairs. They don’t take their medications, their diet is a disaster, they don’t exercise enough, and they smoke more than people in other European countries. But I think that the government and the medical profession must bear a great deal of responsibility for the fact that basic medical information fails to reach the population. I am always astonished at how ignorant even college-educated people in Hungary are when it comes to health issues.
However sobering this study is, I don’t think it will have much effect on the quality of Hungarian health care. When only recently a relative of mine, a retired physician himself, had to wait three months for the results of a prostate biopsy, one cannot expect better outcomes.