The Hungarian healthcare system is seriously flawed. When, back in 2006, attempts were made to rationalize and improve the system, because of the joint “efforts” of the medical community and Fidesz (then in opposition), even the very moderate reforms were derailed. Since then, if it is possible, the situation has become worse. By now Hungarian healthcare is described as already in ruins or, as Tamás Mészáros said in his latest op/ed piece in Népszava, it is moving step by step toward bankruptcy. An important, though not the only, reason for the sorry state of healthcare is an absence of funds. Unfortunately, throwing good money after bad won’t make things substantially better. The whole system is rotten to the core.
Last week there were two cases that upset the public and brought home the message that something has gone very wrong.
A couple of days ago a certain József Németh died on the operating table. He had lung cancer. Considering that 27% of all deaths in the country are due to malignant tumors, this wouldn’t normally be a newsworthy item. But this man’s case was different. RTL Klub got hold of his story in early June. It turned out that almost a year earlier he was diagnosed with lung cancer. But instead of receiving immediate treatment, he was bounced from doctor’s office to doctor’s office. RTL Klub gave a brief background to his case and had an interview with him as he was entering and leaving a small pulmonary clinic. The patient wondered whether perhaps the doctors were sending him hither and yon because “he is poor and from the countryside.” Otherwise, the man seemed to be quite well-informed about his condition. The doctors told him that this was his last chance and that he would have had better odds ten months earlier when the lung cancer was discovered.
A few days later RTL Klub returned to the case of József Németh and reported that the doctors were still at the diagnostic stage. Indeed, it took another three or four weeks before at last he was operated on. It was far too late.
I suspect that, in many cases, these lengthy delays are responsible for the negative outcomes of medical interventions. There are hospitals where patients have to wait for months for an ordinary biopsy report when we know how crucial early intervention is in the case of cancer. And then, after waiting for the diagnosis, comes another wait, this time for the operation itself.
The remedy the government has offered is no fix at all. Gábor Zombor, the latest man chosen to revamp Hungarian healthcare, announced the other day that patients suspected of cancer must receive a diagnosis within three weeks. Given the limited resources (it is only now that funding for healthcare has reached the level last seen in 2005), the special treatment cancer patients receive means that in other equally important fields, let’s say heart disease, the wait lists will be even longer than they are now.
According to a list of 34 OECD member countries, Hungary ranks thirtieth in spending on healthcare. On a list of 193 countries of WHO member countries, Hungary is 41st. Spain spends $3,072 per capita on healthcare; Hungary, $1,689. Admittedly, Romania trails Hungary badly, ranking 69th on the WHO list, at $881. I was therefore surprised to hear that some Transylvanian doctors who moved to Hungary in the early 1990s are now going back to Romania because the Hungarian system has become too chaotic and unpleasant. And reports about Hungarian doctors working in Norway, Sweden, Germany, or the United Kingdom, who naturally welcome salaries 8-10 times higher than their Hungarian pay, nonetheless stress differences in the quality of working conditions and life in general.
The death of the man who had to wait almost a year for his lung cancer operation wasn’t the only shocking medical news of the week. Sonline, a local online paper in Somogy County, reported on Wednesday that István Seres of Nagyatád couldn’t wait for the operation they promised him for September. The man had a large blood clot in his leg which was unbearably painful. He has had health problems all his life and has been in and out of hospitals, so he is quite knowledgeable medically. He knew that the blood clot could move to his lungs or heart, a potentially life-threatening situation. He was also worried that since his leg had been feeling numb, it might eventually have to be amputated. He obviously knew his way around the medical system because he managed to tell his worries to the deputy director of the hospital, who “arranged that they would give [him] an immediate appointment at the vascular surgery section of the hospital.” Otherwise, he would have had to wait for weeks for an appointment. He was called in for an ultrasound and was told that he will be operated on sometime in September. All that took place in mid-June. But by the end of July he was in such pain that he no longer could stand it. Since three years ago he had a blood clot in his leg removed, he had a sense of the procedure. He decided to operate on himself. He managed to remove a clot one cm wide and six-seven mm long. A video of the operation can be seen here–if you’re older than eighteen and have the stomach for such things.
As you can imagine, the Mór Kaposi Hospital in Kaposvár wasn’t terribly happy about Seres’s DIY operation. First, the spokesman for the hospital told reporters that the hospital is not allowed to say anything about the condition of a patient, but a few sentences later he claimed that Seres’s condition hadn’t required immediate intervention. Here again the problem was similar to the case of the man with lung cancer–a dangerously long wait. Seres might have gone too far when he decided to operate on himself, but his act shows Hungarian patients’ helplessness in the face of a system that is becoming increasingly dysfunctional and at times uncaring. I don’t understand why the doctors didn’t try using some kind of medication that dissolves blood clots. Or, if that treatment was not appropriate in Seres’s case, indeed immediate surgery would have been in order. A good summary of blood clots and their treatment can be found on the website of the American Society of Hematology.
Mind you, Seres must be a difficult patient. A year ago, in the middle of winter, he walked out of the hospital in his pajamas because there was no ambulance to take him home. He wanted to show that there are serious problems with the ambulatory service. In fact, our man was correct. A lot of people die for no good reason just because the ambulance doesn’t arrive for hours. Or because, instead of taking the patient to the appropriate hospital, the ambulance driver goes from hospital to hospital in Budapest because one after the other refuses to take the patient.
Like practically everything else in Hungary, there is a huge gap between the care the well-off and well-connected receive and the care afforded to ordinary or, even worse, poor Hungarian citizens. Healthcare might be a state enterprise, but not all citizens are equal in the eyes of the state when it comes to medical treatment.