The Health Consumer Powerhouse just released its “Euro Health Consumer Index” (EHCI) for 2017, and Hungary ranks near the bottom of the list of 31 countries in Europe. Sharing the honor with Poland, the country is in 29th place with a score of 584 out of 100. Hungary managed to fall behind even Montenegro (623 points) and Albania (596 points). Only Romania, Lithuania, and Greece scored worse than Hungary.
Let me quote what the authors of the EHCI had to say about the reasons for the disastrous performance of the Polish and Hungarian healthcare systems. After noting that these two countries, “despite having good and plentiful medical education and a long tradition of solidarity-financed public healthcare,” have done poorly on the yearly EHCI reports, the authors expressed some puzzlement over the reasons for the poor results. Eventually, they hypothesized that “in recent years, the governments seem to have focused on things other than the optimal running of the country, such as killing off the free press, politicizing the judicial system, keeping out also very modest quotas of migrants and banning abortion in all but the most extreme circumstances.” This last assertion is true only for Poland; in Hungary access to abortion is one of the few categories in which Hungary excels. The report notes that “ongoing political discussions on fundamental reform in Poland and Hungary have yet delivered little” and that “the public and the medical profession deserve better.”
This explanation for the shortcomings of the Hungarian healthcare system is far too simplistic. In their executive summary, however, the authors offer some general observations about the ingredients of successful healthcare systems, which are lacking in Hungary. Among the worst problems in the Hungarian system are the abominably long waiting lists. Pouring money into healthcare wouldn’t automatically produce a more efficient system. As EHCI puts it, there is “no correlation between accessibility to healthcare and money spent.” It is inherently cheaper to run a healthcare system without waiting lists than with waiting lists, they contend. And here comes something that Hungarian healthcare providers have a hard time of swallowing: “Healthcare is basically a process industry. As any professional manager from such an industry would know, smooth procedures with a minimum of pause or interruption are key to keeping costs low!”
The above claim is anathema to most doctors as well as to right-wing Hungarian politicians. When Viktor Orbán was still in opposition, he declared emphatically that “healthcare is not a business.” And I’m certain that most Hungarian physicians would protest at anyone calling their profession a “process industry.” They even object to the basic philosophy underlying the Health Consumer Powerhouse’s notion of a consumer-based evaluation of healthcare. As István Éger, president of the Hungarian Medical Association, corrected György Bolgár this afternoon, “of course, we deal with patients and not consumers.” So, the Hungarian healthcare system is limping along in an unbusinesslike fashion, with patients waiting for hours or weeks, at the mercy of overworked doctors. Since the profession refuses to look upon their patients as consumers, the healthcare system is simply not geared to satisfying patients’ needs. As long as this attitude prevails, little will change.
It is possible even in a relatively poor country to achieve almost instantaneous and dramatic results. The example EHCI provides is Montenegro, which within one year moved to 25th (623 points) from 34th place by introducing their own system of an open, transparent real time e-Referral system, which radically reduced waiting times. Or there is Slovakia, which improved its score by 71 points in one year. One of the reasons for this marked improvement might have been the introduction of a system of private, add-on healthcare insurance.
The study is 100 pages long and measures almost all categories related to healthcare. While Hungary is for the most part either at the bottom or in the “so-so” categories, there are a couple of areas in which Hungary leads: infant/children vaccination coverage and hours of compulsory physical education in school. The report is chock-full of statistics, which are worth studying.
In vain did I look for coverage of the results of the EHCI in the Fidesz propaganda media. Only a few independent or government critical media outlets reported on the dismal results. In the pro-government Magyar Idők the last article on healthcare appeared on December 28, with the promise that “next year the number of people waiting for surgical procedures will be further reduced.” But in an article titled “Dear Fidesz, not Soros but the Grim Reaper should be stopped!” I learned that wait times have actually increased in the last two months.
In a related investigation, Péter Juhász of Együtt recently decided to learn more about hospital food. A friend of his who was hospitalized sent his rations to him (in exchange for non-hospital food). The hospital food was of unacceptable quality and quantity and was decidedly lacking in vitamins. Juhász endured his experiment for ten days. Predictably, he lost weight.
Csaba Molnár, deputy chairman of the Demokratikus Koalíció, used the EHCI report to make a campaign point: that “during the Gyurcsány government Hungary was ahead of Italy, Spain, and Ireland, while now patients die in the corridor of the emergency room.” Indeed, Hungary’s decline in the last eight years has been staggering. According to “Euro Healthcare Consumer Index 2008,” out of the same 31 countries Hungary was 13th, right after Finland, France, Estonia, Belgium, and the United Kingdom and ahead of Italy and Spain, in addition to 17 other countries. Even then Poland was close to the bottom.
Given this precipitous decline, the year-over-year drops recorded by the EHCI should receive much greater attention from the opposition parties, especially this year, a few months before the national election. The striking difference between 2008 and 2018 should be highlighted and brought home to the Hungarian people, many of who seem to have forgotten that the times before Viktor Orbán were not as bleak as the present government and even some of the opposition politicians try to portray them. And not just as far as healthcare is concerned.