Issues in the Hungarian healthcare system

About two weeks ago Hungarians were stunned to learn that a dead body had been found in a restroom in the Ferenc Jahn Dél-pesti Hospital, a restroom that served visitors to the neonatal unit. Even more shockingly, the woman had died approximately five days earlier. That could mean only one thing. No one had tried to clean that facility for at least five days. Admittedly, it was locked from the inside. But still. For five days? The deceased, it was reported, had been homeless.

Hundreds of questions were addressed to the director of the hospital, who refused to say anything. Reporters couldn’t even find out how often public lavatories in the hospital are cleaned. Eventually a former president of the association of hospital directors informed them that there are no common rules or even guidelines for cleaning hospital facilities. It is up to each hospital to determine how much cleaning and sanitizing must be done to satisfy basic hygienic levels. I find this surprising in a country where there are rules for everything, usually imposed from above.

Vasárnapi Hírlap talked to a representative from an unnamed hospital where patient bathrooms are cleaned twice a day and restrooms used by the public even more often. I would be curious to know whether this was a state hospital or one of the few private ones. At any event, as a result of this shocking case, the public learned that hospitals hire outside firms to clean their premises. Since these companies serve several hospitals, it can apparently easily happen that members of the cleaning staff are not even familiar with the layout of the hospital in which they are working on any given day. Currently an “internal investigation” is being conducted, which normally means that no one will be held responsible.

In cases like this the government papers are silent. Magyar Idők and Magyar Hírlap simply reported the news and added that an immediate internal investigation will be undertaken. A week went by without another word on the subject. But then on December 3 Zoltán Ónodi-Szűcs, the latest undersecretary responsible for healthcare, gave an interview to Olga Kálmán of ATV in which he announced that what happened in the hospital had nothing to do with healthcare. “It is essentially a problem of homelessness.” Suddenly, Magyar Idők got the signal they were waiting for: a directive on how to handle this “unfortunate” affair. Without such a cue, these servile papers are at a loss.

Those who know Hungarian should take the time to watch this disgraceful interview in which the undersecretary’s callousness and lack of concern for his fellow human beings are on display. To his mind, the hospital is in no way responsible because, after all, the door was locked and the cleaning is done by an outside firm. There is nothing wrong with hygiene in general because “there are few countries in Europe where the danger of infection is as low as in Hungary.” As for ambulances not arriving on time for seriously sick people, he offered the following answer: “the ambulances are on time unless more calls arrive than there are available vehicles.” What a brilliant mind. As for the statistical proof of Hungary’s excellent record, it doesn’t exist because Hungarian authorities refuse to reveal the figures.

The beleaguered Ferenc Jahn Dél-pesti Hospital was in the news again today. A couple of days ago the Department of Ophthalmology had to be closed temporarily because the whole floor was infested with bed bugs, but as the hospital assured the public, “the patients were moved from the department which was completely disinfected. The fumigation didn’t interfere with the care of the patients, who are safe.”

And now let’s move on to another piece of news that appeared in Magyar Nemzet, whose staff is doing a great job of annoying the government by finding negative stories. Their latest is a thorough article about the causes of the high mortality rate of cancer patients in Hungary. First, let me quote from a Eurostat study on cancer statistics in the European Union.

Among the EU Member States, the highest standardized death rates for cancer were recorded in Hungary and Croatia, both with rates over 330 per 100,000 inhabitants in 2012…. For men, the highest standardized death rates for cancer were reported for Hungary, Croatia, Slovakia, the Baltic Member States, Slovenia and Poland, all with rates over 400 per 100,000 inhabitants. For women, the highest standardized death rates for cancer were recorded for Denmark and Hungary, both with rates just over 270 per 100,000 inhabitants.

Of course, there are several reasons for these bad statistics. One is Hungarians’ reluctance to have regular checkups, which may be caused in part by the inordinately long wait time (hours) to see the doctor even if the person has an appointment. Second, a person whose GP suspects cancer has to wait months for an examination by a specialist. All the while the tumor continues to grow. Third, and this is what the article is talking about, in Hungary 56% of financial resources allocated for cancer patients is spent on chemotherapy and only 31% on surgical procedures and 13% on radiation. Yet early surgical intervention combined with radiation is the most effective way of treating cancer patients. Chemotherapy as a stand-alone therapy is most often used to prolong lives for a few months in advanced stages of the disease.

Magyar Nemzet’s article is based on a study by The Lancet Oncology, using admittedly old data (from 2009). It shows what percentage of money allocated for cancer treatment goes to surgery, to chemotherapy, and to radiation. In percentage terms, Hungary allocates less than half of what Germany does to surgery and more than three times as much to chemotherapy. For breast cancer patients only 14% of the money goes for surgical intervention and 79% for chemotherapy. For prostate cancer 5% goes to surgery,  92% to chemotherapy. In Germany the percentage of funds allocated to surgery for breast cancer is 53%, for prostate cancer 46%.

Financial resources allocated by different countries
Red = surgery; blue = chemotherapy; grey = radiation

Allocation of funds by Hungary, Germany, and EU average
Breast cancer, lung cancer, colon cancer, prostate cancer

So, if, the article’s conclusions are correct and if Hungarian medicine hasn’t dramatically changed its treatment protocols (which apparently it hasn’t), the country’s bad statistics could be greatly improved by introducing a different allocation system. But that’s not enough. One also needs knowledgeable and caring doctors. It was again Magyar Nemzet that published a story addressing this issue a few days ago. A woman was worried about a lump in her breast, and her gynecologist sent her to a surgeon. The surgeon was either ignorant or negligent. He announced that there was nothing wrong, just a scratch which he disinfected. Then he tossed her a piece of paper that said “kontroll p. e.” P. e. apparently means “in case of complaint (panasz esetén).” The complaints came, and eventually the patient ended up at another specialist who eventually operated on her, but it was too late. By then the cancer had spread. She sued the doctor who let her go without explaining the next step to be taken. After four years of fighting the case in court, the Kúria just awarded her 5 million forints in compensation. Unfortunately, a few months ago she died.

For a doctor to merely give his patient a piece of paper is, of course, not good medicine. But patients also have to change their attitudes toward their own care. Hungarians are not accustomed to asking questions and demanding answers from their physicians. And, I suspect, there are not enough “Google doctors” in Hungary. That is, not enough Hungarians do their homework before going to the doctor. Not enough know what kinds of treatment are most effective and have the guts to argue their case.

December 9, 2016
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Guest

Re the stats:

Of course not only the percentages are important but also the absolute sums which might explain how often cancer is operated on (as early as possible) and how much time is spent on this by doctors.

Not too much OT:
I’m in Germany right now and my friends always ask me how (bad …) things really are in Hungary so I tell them this story with the minister’s conclusion:

Well, it was only a homeless person …

You should see the looks on their faces!

Observer
Guest

wolfi777

Let’s be precise: the minister did not imply it was only a homeless person, he said that homelessness is not a healthcare, but separate issue.

Than said the interview was packed with cynical twists, half truths and lies:
“the issue of a dead person is not the same as the issue of infection”
“it can’t be expected hospital personnel running around checking closed doors” (for safety WC doors have latches that can be opened from outside with a special handle)
“this government had the courage to introduce … we have one of the best [infection reporting] systems… and this is why the number of infections [reported] are higher” (deadly infections tripled 2010-2014, dropped slightly in 2015)

The minister was also arrogant, but not so aggressive, by Fidesz standards.

Ferenc
Guest

About the cleaning in hospitals: if done by outside companies, there should be contracts in which stipulated the requirements for cleaning (method, number of times, etc) and also method of checking for proper cleaning. (note that I wrote “should” and not “have to”)
Hopefully reporters will try to get their hands on some official paperwork between hospitals and cleaning companies, and openly publish them in their media.

Own experience: several years ago I visited a children hospital in Budapest. The building looked from the outside as it was, old, but quit OK for it’s age. Inside it was different: suspended ceiling a mess (waterspots, openings in ceiling, never cleaned facilities above openings, etc.), electrical wiring looked not safe to me (open cabling everywhere, extension cord after extension cord, in short a big and dangerous mess), and then to top this all off a brandnew enormous flatscreen TV on the wall in the corridor for children to watch (probably given by a sponsor, who could deduct the costs in his taxpapers, better if for his money he had ordered revision of a part of the electrical system!).

Ron
Guest

Years ago (mid-90 ties) there was a German company cleaning hospitals. Management was German.

After approximately two years German management was fired (did not know the reason until years later), and Hungarian management (was actually the lower management) took over. The expansion was amazing, growth at least ten fold in one year.

Later on I found out the reason from one of the Germans that the reason they were fired, because they did not want to do kick-backs to management of the hospitals. Once the Hungarians took over they were flying due to the kick-backs, but not due to service and quality.

Furthermore, I believe that due to the fact that the salaries of surgeon is approximately EUR 1,000 per month Gross, and most of them left the country (to Germany, England and some to Spain and Italy is another reason. There is nobody left to do the operations.

The financial reason that the budget of the operations is normally run out by August-October. and if you want an operation you need to pay under the table.

Observer
Guest

Interestingly, while the recently discussed Hungarian “education” system is allocated one of the lowest %GDP in the OECD, the healthcare expenditure is on par with the regional countries – 7% GDP (although lowest in the last 15 years, incl. the crisis years 2008 – 7.3% and 2009 – 7.1%.

The regional systems may be also substandard, but the Hungarian health stats are the worst. So there must be some other reasons for the appalling situation here.
Inhuman (embertelen) treatment of patients disregarding individual needs, of such treatment of junior medics chasing them abroad, professional arrogance narrowing/restricting knowledge , corruption draining the resources or incompetence in distributing them ?
Any studies on the possible reasons ?

Alex
Guest

I read this article with great interest. Thank you for revealing the statistics. But the knowledge of the orthodox cut/burn/poison solution to curing cancer is only tangential to the elephant in the room: what is causing the rates of cancer in Hungary?
What is the percentage of people who smoke? (I am willing to bet it’s in the high double digits.) What is the percentage of alcoholism? What kinds of toxins like preservatives, additives, pesticides and more are now included in the food supply, cleaning products, and household materials?
The issues of basic good health versus catastrophic health must go back to the source of disease as the first step of prevention. I posit that health education and health awareness are both sadly lacking here. Even the best doctors and the orthodox methods used at this point cannot cure someone whose habits are carcinogenic to begin with.

Guest

I don’t have any stats at hand but I remember reading that alcohol consumption (especially pálinka) is very high in Hungary and from personal experience in the village I know that tobacco is another problem as is food – many people, especially pensioners eat as if they were still hard working. So obesity and diabetes etc are rampant.

But that is ageneral problem for all developed aka rich countries and yes, there should be more info on the health risks for everybody!

I often tell a bad joke about the lower life expectancy in Hungary, especially for men:
If they don’t drink and smoke themselves to death – then their wives feed them to death!

Guest

Re: life expectancy

After reading this piece and without getting into details I think I would not be here if my life and home resided in the country. I’ve come to the conclusion that those at the top of Magyar healthcare establishment have somewhat different expectations and approaches to human existence. If they are doctors of medicine I suspect they need to be more urgent in engaging on the humanistic philosophy of it.

webber
Guest

The cancer rate is one thing, the likelihood that those with cancer will die is another.
Interestingly, the part of the country with the lowest death rate to cancer is also the poorest part of the country, the N.E. part next to Ukraine. Unfortunately, in this case I suspect the cancer rate is lower because people are so much more likely to die young from other causes. The life expectancy in this region is lowest. So, people are dying before they can get cancer in the N.E.

e-1956
Guest

Balogh Blog – where are you going?

Political, military, civilian, academic leaders must see the big picture.

Details will be solved after a regime change.

Healthcare is an important subject but remains a detail.

Let us define the central questions. I am waiting for your mission definition.

Observer
Guest

Ceterum censeo Orban delenta est.

2016
Guest

A good idea but instead of destroying orban, Hungary can be saved by banning him faraway.

bimbi
Guest

@ e-1956, 8:44 a.m.

Keep reading, but meanwhile

Sha da fa cup!

2016
Guest

Relax!

Guest

Not too much OT:

There’s no reason to be complacent – even in the USA death rates are rising, life expectancy is sinking!
That may be a temporary blip, but the underlying reasons like obesity, drug abuse are going to stay -that goes for all of Europe too!
https://www.washingtonpost.com/national/health-science/us-life-expectancy-declines-for-the-first-time-since-1993/2016/12/07/7dcdc7b4-bc93-11e6-91ee-1adddfe36cbe_story.html?utm_term=.4819ee97a853

bimbi
Guest

The whole question of the availability of quality health care in a country is of utmost importance. This is simply because health care should serve the whole community and along with defence, education, provision and maintenance of infrastructure is the fundamental responsibility of any government (oddly enough this is not stealing).

What seems to be happening in Hungary is that excellent health care exists (first and foremost for the politicians) but is available to only very few of the public at large. The Oncology Institute in the XII district is excellent but visit the place and you will see how desperately crowded the facilities are. Remote from Budapest, I shudder to think what care and treatment is available – probably rather little. Thus the government fails in not providing health care for the population as a whole via regional centres. Until this is done, diagnosis and death rates will be far too high.

For 6 ½ years Orban has FAILED in this duty because football stadiums and stealing were ranked higher on his priority list. Quality health care CAN be provided. People have to demand it from this government

zwaart
Guest
The differences in spending on various therapeutic options can be explained by two facts. Firstly, Hungarians go to their doctors much too late though admittedly the system itself is extremely slow (and there are criminally negligent practitioners). Obviously at such a late stage operation isn’t an option. Secondly, the corruption of the hospital management: cuts from drug procurement is a major source of income for many in the system. There is really no control over spending on drugs in a way there is in Germany or the UK (Hungarian hospitals are always bailed out of their debts to drug suppliers), plus patients and their families feel that the patient is cared for if there are drugs involved. Having said that, the majority of the life expectancy gains in the West can be attributed to a few circumstances. The most important is the general decline of smoking and of alcoholism, though the decline of alcoholism is just another way of saying better living standards. In some areas such as colorectal cancers regular testing significantly decreased mortality. In other cases, however, most importantly in the cases of prostate and breast cancers there seems to exist now a consensus that early diagnosis does… Read more »
Alex
Guest

I firmly believe that if people had health education from multiple sources (especially peer opinion, the most powerful) people would begin to realize how the government’s collusion with the tobacco industry is a huge travesty for each and every person who smokes. The govt is profiting from every person who smokes and dies of lung cancer! I would love to see people in the streets protesting this like their lives depended on it.

Ferenc
Guest
OT: press in Hungary Just watch a fascinating talkshow, with as guests two (former) editors-in-chief, one of Nepszabadsag, the other of index.hu. For who understands (even a little) Hungarian, here you can watch it http://hirtv.hu/alinda/muranyi-andras-es-dudas-gergely-1375561 They talk in-depth about their experiences in their (former) jobs. If I could I would have like two more things to have happened in the show: 1.pressure on Muranyi about who were the people giving him sometimes unofficial “information/advices” (may be he didn’t want to say names for protecting his sources, but why, he’s stepping out of the press business) 2.when there was talk about influence of owners, I would have liked when the two guests would have turned the questions to the host about things at HIRTV, I mean there have been changes there in the last couple of years Another thing where I’m very interested in, if somebody can provide a full translation of the talk (English, German French, whatever). It would be nice to get this interview shown to foreign editors-in-chief, and I am really curious for their reactions, two possibilities: a.they consider what they see and hear as business as usual (so that’s it, case closed) b.they find things going ‘strange’… Read more »
Ferenc
Guest

Just found that it’s also on youtube: https://www.youtube.com/watch?v=wDa8GJYmQ-c
unfortunately also here without subtitles, but will ask for it

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