The failure of the Hungarian healthcare system: Two recent stories

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.

Mór Kaposi Hospital, Kaposvár. The sign says: "Emergency Ambulance"

Mór Kaposi Hospital, Kaposvár. The sign says: “Emergency Room”

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.

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LwiiH
Guest
Hospitals have to delay procedures because there is not budget it for them. I know a couple of person that need biopsies but they can’t get them because the hospital ran out of the supplies needed to perform the procedure. One of the patient’s husband is a doctor. Contrast this to the private clinics that are thriving in Budapest. No one in Budapest would go to a hospital unless they were forced to which I bet means no politician goes to a hospital. However, ending up in the private clinics systems means you have no GP monitoring you which means healthcare is dispensed piecewise instead of some sort of orderly fashion. And there are many quacks that will offer very questionable procedures. From my vantage point, there is no national health care system or strategy. Never was, it’s always been in a shambles. Just lately it’s worse. OT, the anti-refuge propaganda is pretty effective. I see that people are now afraid to go to the train stations for fear of catching some unknown diseases or ending meeting a violent death. Everyone thinks there are enough camps, just too many people ending up in Hungary. The one failure is that everyone… Read more »
Webber
Guest

You should add that the (vast) majority of Hungarians cannot afford private health care, and that all working Hungarians are paying for public health care through involuntary deductions from their paychecks.

tappanch
Guest

Let me add that the Orban government ordered a few years ago that no patient can be admitted to hospital without going through the hellish bottleneck of the emergency areas.
Should s/he survive this place, the patient can get treatment.

This happened to my mother two years ago. A doctor told her to get treatment in a hospital. But we had to wait 8 hours in the emergency area to get admitted! There is not even potable water in the area.

exTor
Guest
There may be certain factors [eg: hospital location, nature of admission, time of day, day of week, etcetera] at play that affected what occurred to your mother, tappanch. As my health is quite good, my experience with hospitals in Toronto has thankfully been limited to personal (eg: sports) mishaps. My worst (with respect to time) was at East General where I waited 6–7 hours for stitches to my hand. Breaking my clavicle (collarbone) biking at age 59 was no biggie. In and out of Western in about 2 hours, which was about the time it took to deal with a major ankle injury [rugby at 37] at Sunnybrook, which is my fave hospital of my limited experience. This is not to alibi the hospital where your mother was treated, tappanch, nor is it to detract/distract from Éva’s article. The hospitals in Hungary have to work with the bad situation in which they are stuck. Relatedly, I’m playing with fire here in Hungary, where I dont have medical coverage. I’m relying on my good health and good luck to get me through, however the latter came up short when I rebroke my collarbone a half year ago at age 65. I… Read more »
Webber
Guest

Also, to get certain expensive, life-saving drugs (esp. one for diabetes, and some to treat cancer), it is no longer enough to have a doctor’s prescription. A medical board, set up by the Ministry, must get an application from the doctor to administer the drug. If the board comes up with a positive decision, it will then ask for further documentation proving that the patient’s condition is still critical. After that documentation comes through, the board will (or may) say “yes.” This takes months. By the time the approval comes through, it may be too late. This new procedure was introduced by the Fidesz government. Before, a doctor could simply prescribe the drug and the patient got it immediately.

Nádas
Guest

And in the case of Type-2 diabetes, regular twice-a-year blood-work is now required, and if the results are higher than an arbitrary limit, the patient must then pay out of pocket for his or her own injectable insulin. A diabetic who follows the prescribed dietary regimen should have no problem. One who doesn’t could wind up paying 60,000 forints ($215) a month. Typical average pensions run about twice that.

Rikard
Guest

Re: “You should add that the (vast) majority of Hungarians cannot afford private health care, and that all working Hungarians are paying for public health care through involuntary deductions from their paychecks”

You know I recently saw a video on Hungary produced by a PBS station in California back in ’86. It was titled ‘Pushing the Limits’ as it showed how the country was operating under the Kadar regime at the time.

Regarding services, it was noted the health care at the time was ‘free’ to all Hungarians (I’m sure the government overseers of the piece done by foreigners would make sure that was in there). Looks as if paying for it with an arm or a leg now doesn’t appear to give them improvement considering cost and the time they had to ‘fix’ the health system.

Webber
Guest

No health care is ever free – not even under Kádár. Hungarian working people were paying for that then too. These days the mandatory deduction from paychecks is not by any means a small percentage of gross (brutto) pay.

Guest

Re: ‘No health care is fever free- not even under Kadar’

Yes you are correct. I didn’t go for the line the Kadaristas were trying to push. I could tell you more about the piece but it would just depress. Problems with health, housing for families and Hungarians taking more than one job to make ends meet was the further story. Pretty dismal time where Hungarians just had to slog through. It was enough to make everybody suffer from something during that oh so wonderful era of ‘gulyas’ communism. That adjective makes me so sick I can’t eat it anymore. It would put me in the hospital as the fat would congeal in my arteries. And that’s the trouble with ‘tasty’ things they’re seemingly real good but you can get slowly killed enjoying it.

NKabcen (formerly nwo)
Guest
NKabcen (formerly nwo)

A quick note onRomania. The state system is also in terrible disarray and is deeply underfunded. Recently, with a lot of hiccups, they are introducing a new comprehensive IT system for patients. Anyway, the big difference in Ro as compared to Hu is the presence of a growing private sector healthcare system which offers superior services, lower wait times etc. then state system. Bucharest has many private hospitals while Bp has as far as I can tell zero at present. An openness to private capital will attract back Ro Drs and hopefully improve the overall quality of healthcare in Ron(eventually).

buddy
Guest

There used to be a private hospital in Telki, but according to its website, it was purchased by an organization called the Róbert Károly Private Hospital, who moved it to Budapest. (Although I actually drove through Telki last weekend and noticed that the sign pointing to the hospital is still there for some reason…)

There’s also the private Duna Medical Center, which is currently located in the Millenium office complex, but they are building their own private hospital at the corner of Soroksári and Haller u. But that site has been under construction for at least 8 years as I recall, so who knows when it’ll actually be finished!

There are probably other private medical services in Hungary, but these are the ones I’m aware of.

Zsolt
Guest
And all these are known facts…. Couple of years back the Gyurcsany administration wanted to bring litle money into the health care, directing a direct money to the doctors. It was 300HUF, less then one euro(that time) for each visit up to 20 per year. Anyhow, without money there is no healthcare. Let’s do math, About to 3Millo of the Hungarians are working, And they pay some tax and social security. Let’s assume, each of them have a good salary, so they pay 200.000HUF social security per month. According to: http://topceg.info/tartalom/adokulcsok-jarulekmertekek-egeszsegbiztositas-fizetendo-jarulekok-2014-ben So please correct me, but the all amount of monthly tax for healthcare does not reach the 100EUR, which is a joke! Comparing what I pay as a freelancer in Germany it is peanuts, banana and a good reason why the entire healthcare system is down. Anyhow, I must argue with the post… In the past days / weeks there were three big stories. The third not mentioned here is about the status of a hospital in hungary / Budapest. Where the patients were chained to the heating, there were only a toilet where man and woman were not separated, where the wall was disgustingly wet. Anyhow again… This… Read more »
karmester
Guest

Everytime I visit Hungary I am amused by the fact that EVERYONE I do business with, even for the SMALLEST thing, puts a receipt in my hand… day after day, my pocket is full of receipts.. They seem impossible to refuse.. so I don’t know what you’re talking about there… I think it’s a legal obligation that everyone observes… in my experience of visiting for 2 – 3 weeks 2 – 3 times/year.

Zsolt
Guest

right; I also hate that ( called: Nyugta ) however, if you do not receive you can be sure no tax was payed. I also hate it.. and in Budapest; you mainly get. In my “hometown” I had to “teach” the bakery to give one ( at least to me ).
Even, if you are not alone you almost automatically get one as they think you are from tax authority.

Guest

Of course if they don’t know you …

But if you’re a repeat customer and you’ve become friends they might ask you:
Szaámla kell?
And of course the price is much lower then – at least that horrendous 27% Afa aka VAT is not added …
Sometimes they even give you a receipt for a lower sum – if you agree to that, like:
I can’t do it without any paperwork ..

Zsolt
Guest

Haha 🙂
Yes…
We can agree, we can not describe what 27% VAT means… but every time you do not pay this tax you steal from you and your family.

Say this sentence to a Hungarian (maybe not in some big cities like Budapest) and they will smiling without end, saying you are stupid, as the administration is misusing the money, etc… other excuses…

Webber
Guest

“every time you do not pay this tax you steal from you and your family…”
Hmmm….
I think rather that the money is better spent directly by my family.
Other people think that by not paying that tax, perhaps, they are not contributing to the construction of another over-priced stadium built by Fidesz party people, in which fifth-rate corrupt football will be played – a stadium, moreover, that they will never visit.

Zsolt
Guest

That is fully true; I believe in the ‘free market’ 🙂

But; we are living in a society, where such think like tax are an important part of the life.

And yes, the FIDESZ is misusing the money, but, to change this we have election in every four years. To say, guys, it was not good…

Webber
Guest

Instead of sums, think of percentage of salary. The percentage Hungarians pay in tax and specifically for health care is not small in international comparisons (it is higher, in percentage, than tax paid by most Americans, for instance). Hungarians earn a lot less, on average, than most other Europeans. If you just look at sums, you may incorrectly think it is a small amount.
By correct calculations, roughly 40% of Hungarians have less than a living wage.
http://www.blogolod.com/mennyi-lesz-a-letminimum-2015-ben-meglehet-elni-belole.html
For these people, paying a hundred or two hundred Euros a month is an unbearable burden.
http://www.origo.hu/gazdasag/20150707-megvaltoztatja-jovore-a-letminimum-szamitasanak-modszertanat-a-ksh.html

Zsolt
Guest
Webber, I do agree; However, you do not pay in percentage but pay in sum. One treatment has a price, which can be payed either by the patient or by the state, or in a share. But at the end of the day you do pay a sum. Not sure where you are from; but in Hungary nobody knows what is the real price of a treatment. Anyhow; I do understand the wages in Hungary are lower, I not just understand but also knew it on my skin… So again, still do not know where you are from, but in Hungary EVERY single treatment are payed off 100% by the “social security”. Funny; in Hungary many takes private dentist; however it is 100% covered by the state. And really, all the spectrum between a flue and the brain surgery are covered. In Europe the social security has some limitations; for example: – If you take the statutory healthcare there everything are covered; however not on the “top level”. You do not get a one bad room, or priority or etc… – You can take the private one; and you get everything what you wish to imagine; however, and there is… Read more »
Webber
Guest

I have rather intimate knowledge of Hungarian health care systems and taxes (which you might have guessed, based on the links I posted).
Everything you say is okay except 3 things 1. what you say about “in Europe” is not true because there is no unified practice “in Europe.” Instead, every country in Europe has its own unique health care system – and for that matter, Hungary is “in Europe” too. Britain has one system, France another, Germany yet another, Sweden something a bit different, etc. (I like the Swedish system best – but those details are unimportant here)
2. In Hungary, people who are unemployed do NOT get automatic health coverage. After a certain amount of time, everyone must pay a certain fee per month to stay in the system, otherwise they are not covered. That fee is not so small.
3. You did not say a word about “paraszolvencia”, that is the tips that doctors and nurses expect in Hungary – but then, I didn’t say anything about it either.

Zsolt
Guest

correct; I should better specify. I was talking partially about “mylifestory” in Germany.

Nádas
Guest

Just a nitpicking point: “Sürgösségi ambulancia” is probably best translated as “Emergency Room”. An ambulance, of course, is a “mentőautó”.

buddy
Guest

I’d like to bring up another issue about health care in this country. I recently met a Hungarian doctor (can’t remember her specialty) who moved to Britain. I asked her, “Other than the pay, what’s the biggest difference between practicing medicine in England versus Hungary?” She told me, “In England, the doctors admit it when they make a mistake. Here (in Hungary), doctors never admit their mistakes.”

So if you’re a victim of medical malpractice in Hungary, good luck trying to get any sort of restitution, or even someone to admit that they screwed up!

I guess it shouldn’t be surprising though – I think by and large Hungarians generally have trouble owning up to their mistakes, so why should this be any different. I have enough difficulty trying to get a cashier to acknowledge she shortchanged me, or a waiter in a restaurant to recognize that he mixed up my order….

petofi
Guest

@buddy

Man, you’re as green as a baby shoot in April.
Everything I’ve read from you is eye-deep in naivete. ‘Own up to mistakes’? Are you kidding..? Do you know what Hungarians–even family members do–with ‘mistakes’? They turn it on its head and make it seem as if YOU had committed the wrong. Typical.

As for compensation from doctors…? Get real. There’s a social stratification that puts doctors among professionals who are generally considered to be ‘superior’ and who expect and get preferential treatment. No doctor would ever be sued. First off, the judge would be bribed–end of case. There’s no such thing as malpractice. Ok, maybe a quack gets arrested and wrung threw the legal system, but that’s about it.

Get real and see the situation for what it is in Hungary: social justice
is back to the 1900s if not earlier.

Guest

An observation:

My cousin back in the 70’s was married to a doctor in Magyarorszag. Our family thought it was great. But the interesting thing was that we received a letter asking if we could send medical books for use in his study. He couldn’t get them. Well that was really out of the question since there was no way for us to fund that.

As for myself I did begin to raise questions on the health care system then with that particular request. I mean if doctors themselves couldn’t even get books something had to be wrong. And I learned more and it wasn’t to the credit of the state. Still isn’t. Fact is the people who run things simply just don’t care about an avowed pursuit of life, liberty and happiness. I ask why the dismal orientation after all the years. Tell me please. I just don’t understand. The Hungarian state has a bad habit of continually putting itself on the important things.

zana
Guest
If voters are unhappy with the present health care system then they will vote for politicians who would want to deliver a better system. Too bad that no voter ever voted on a single rational policy issue. But generally voters get what they want and this is what they wanted: a bellicose, nationalistic, corrupt Fidesz instead of the clueless, corrupt left-wing. Fidesz simply couldn’t care less about the health care industry since all doctors (the important decision makers in the system and rural opinion leaders, the elite) are fidesz voters by default and the moment you touch the system the opposition (at least a competent opposition like the Republicans) will shred you to pieces. Better to leave the system as it is, it won’t cost any voters and that’s what Fidesz does. I know very similar horror stories about elderly folks who barely survived absurd mistreatment in rural Hungarian hospitals but they and their families are still ardent fideszniks. They like the system just fine, they got used to it and they have no expectation of a better one and they would rather cut their limbs before they would vote communist or liberal (“who want to sell out health care… Read more »
Zsepac
Guest

I am convinced that health care is underfunded by design not merely due to budgetary constraint. It is intentional to kill off the unproductive sick, old, uneducated, minority etc. population instead of spending on retirement, disability, welfare, etc. As you write the well off and well connected get decent medical care in Hungary even with underfunded system with lower and lower number of physicians and other trained healthcare workers.

Guest

I’ve also heard real horror stories about health care in Hungary and my wife is used to paying extra or going directly to a private specialist.
On the other hand my own experiences in the Keszthely hospital weren’t so bad and a friend of ours who had leukaemia (they couldn’t help her in the long run) got good treatment in the specialised hospital including radiation treatment and lots of blood transfusions which as a pensioner she couldn’t have paid for herself.
So I’d say that many (if not all) people in the health care system here in Hungary give their best, but many are frustrated because there is not enough money!
So to me this is (not only, but mainly) a financial problem, staff are underpaid and overworked, technology and drugs are not available etc …

PS:
In richer countries too like Germany etc not all is well – we have a proverb:
Weil Du arm bist must Du früher sterben …
Because you’re poor you have to die sooner!

Zsolt
Guest

Andere Baustelle; https://de.wikipedia.org/wiki/Weil_du_arm_bist,_mußt_du_früher_sterben

And this is not true.
If you can not afford the social security the state helps you, HOWEVER not with 100% coverage, but I am pretty sure;
– nobody will die in Germany who can not afford a monthly fee
– even not in the USA, where social security is an early bird 🙂

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