Tag Archives: healthcare

The past seven years: Hungary in numbers, 2010-2016

Máté Veres, research associate of Gazdaságkutató Zrt., published this study in Új Egyenlőség at the beginning of the year. The article was translated by “Observer,” who added the following notes:

This article offers a set of indicators to reveal the state of the Hungarian economy and society. We think, however, that the situation is somewhat worse than Veres’s assessment because there are additional detrimental factors not discussed here, e.g.:

  • The very low investment rate as a percentage of GDP
  • The budget deficit hidden in subsystems down to individual units like hospitals or schools districts
  • The consumption boost by the remitted earnings from abroad, which are to decline in time
  • The poor ratings of the Hungarian places of higher education, the outdated, retrograde education model and policies, the very low number of people with IT or foreign language knowledge, etc.  

Analyses of these points will eventually be presented in another article. I’m grateful for the work and care “Observer” took in translating this important article for us.

♦ ♦ ♦

Analyzing the results of the second Orbán government [and third as from 2014] after seven years of freedom fight and other kinds of struggle and hundreds of millions of euros from the EU spent, it’s time to draw a picture of how the Hungarian economy and society are doing compared to 2010 in the light of the latest figures available.

After [the election victory in] 2010 the government benches have been widely using the already well known “past eight years” phrase. It was used by Fidesz and the Christian Democratic politicians as their favored counter-argument when the opposition tried to challenge government actions. The performance of the governments between 2002 and 2010 in many areas could have been criticized (as we did in our analyses), but in general the “last eight years” argument has always been a simplistic communication tool, often used to bypass substantive discussions. In our evaluation of the Fidesz government performance we now follow a different path and instead of summary political statements we shall stay with the facts and figures to show what the “past seven years” were like.

Seven years are already a sufficient horizon for an evaluation of the government’s achievements. For this purpose, however, in addition to showing the changes in numbers, we need to find explanations for the results, and therefore – where possible – to compare the results with those of our regional competitors as well. So now we’ll consider some areas of key importance to the future of the country.


It was 10.3% in 2010 and only 5% in 2016, according to the KHS (Central Statistics Office-CSO), or 6.8%, according to Eurostat.

Apparently the situation has improved, but it is worth adding that the [2008 world financial] crisis played a major role in the exceptionally weak 2010 numbers, while the much better 2016 numbers include both those working abroad and those fostered workers vegetating on subsistence wages (USD 180/month).

The same factors underlay the Eurostat numbers showing a miraculous growth of employment in Hungary (59.9% in 2010 and 68.9% in 2015). According to official figures we caught up with the EU average, but without those working abroad and the fostered workers we just caught up with the eastern [EU] member states. In any case, there is an improvement, primarily due to the EU-funded, labor-intensive construction projects.


2010 – 36th place, in 2016 – 44th

Human development is an indicator introduced by the UNO, a concept of human well-being wider than the GDP indicator. It is generated by averaging three numerical indicators: life expectancy, education and standard of living (GDP Purchasing Power Parity per capita). In this area we not only managed to fall significantly behind, but all our V4 [Poland, Czech Republic, Slovakia and Hungary] regional competitors overtook us, while Poland was still behind us in 2010.


EUR 7,844 mil in 2010, 5,683 mil in 2016

A clear success can be booked in this area. The composition of the debt is just as important as its size, as the crisis taught a large part of the Hungarian middle class. Until 2010 the household debt of the Hungarian population grew at a rate remarkable even by regional standards, and in foreign currency, which was mainly due to the bad interest rate policy of the Hungarian Central Bank (HCB) and to the lack of regulation. The central bank’s interest rate policy between 2001 and 2007 encouraged the population to borrow in foreign currency.


In 2010 the PD was HUF 20,420 billion or 78.8% of GDP. Seven years later, in 2016 it was 25,393 billion or 75.5% of GDP.

This figure has fluctuated during the second Orbán government. It had been over 80% GDP too, but at the end of the year ‘with hundreds of tricks’ – the best known being the seizure of the pension finds – they always managed a decrease from the previous year [the government publishes and uses only a single figure – that of Dec. 30th). There is a lot of uncertainty as to whether the government can sustain the downward trend, given the scale of the debt, but if it manages to keep the balance of payments at zero, the government can eventually claim a clear victory on this front.


In 2010 the total was 54.1%; in 2016, 49.0% There is a sizable literature on the issue. The differentiated and on average higher taxes on labor and/or profit are not at all problematic, if they are used by the state to provide high-quality, accessible to all, health, education and other services. This is evidenced year after year by the results of the economic systems of Sweden, Norway, Denmark and Finland, known as the “Nordic model”, since the above-mentioned countries have figured at the top of the lists in competitiveness, innovation and the environment for decades. However, in Hungary things are developing in a direction exactly opposite to the Nordic Model. This question is also interesting because the Fidesz government proclaimed itself to be the government of tax cuts.

Social security expenses in the European Union, 2014

It is clear that if we look at the overall situation, the taxes on labor have decreased. Although it’s worth adding that in international comparison while in 2010 we had the second largest burden rate in the OECD, by now we managed to move up only by two places, occupying fourth place from the bottom. This small success is mainly due to the introduction of a flat personal income tax and its rate reduction to 16%.

However, it’s worth mentioning that the replacement of the progressive tax system used until then by a flat tax rate opened a HUF 444 billion hole in the yearly budget and benefited only the richest. In addition, never has labor in Hungary been burdened by such a wide variety of taxes as today. Actually the situation here is the worst in the region. Meanwhile the government promised a massive tax burden reduction in the medium term and a single-digit company tax. There has been a long-standing debate about the need for a significant reduction of the tax burden with regard to the competitiveness of the economy.

In any case, despite the 2010 promise, we surely didn’t get any closer to the “beer mat-sized tax return” [as V. Orbán half-jokingly promised in opposition]. However, with the new flat and extremely low 9% company tax rate, another 2010 slogan – “we shall fight the offshore knights” – now seems to have morphed into “join the offshore knights’ race.” Similar to the effect of the flat-rate personal income tax, now once again the richest (and the big companies) will do really well as not the Hungarians, but the multinationals, such as General Electric (GE), already did under a special agreement with the government.


Between 2004 and 2010 the growth amounted to 9.9% or in absolute terms USD 114.2 billion to 129.4 billion (a 15.2 billion difference). Between 2010 and 2015, in the same length of time, the Orbán government boosted the GDP from USD 129.4 billion to 138.8 billion (a 9.4 billion difference). The right side of politics clearly underperformed. These numbers, however, may be deceptive because much depends on external factors. But if you just look at our competitors in the region, save for the Czechs and Bulgarians almost all Eastern European member states, even Romania, performed better.


The [public transport] ticket price in Budapest in 2010 was 320 Ft., in 2016 – 350. The ticket prices in the region were as follows in 2016. Sofia – 158 Ft., Bucharest – 90 Ft., Warsaw – 240 Ft., Prague – 275 Ft. So the situation remains unchanged, we are the most expensive.


During the Gyurcsány government overpricing [in public projects] gained notoriety, but there are still no authoritative studies regarding its extent. Interestingly, according to Zsuzsanna Németh, Minister of Development 2010-2014, the Hungarian freeway construction cost per kilometer had decreased steadily during the Gyurcsány government, and in 2010 was 1.8 billion Ft. on average. Compared to this, according to the same Ministry led by Zsuzsanna Németh, the freeway construction unit cost had increased to 2.3 billion per kilometers in 2013. But there were also sections where the costs reached almost 4 billion forints.


[Or how many minutes you have to work for a Big Mac]

Crisis or not, the change here is clearly positive: in 2009 – 59 min., in 2015 only 44 min. That said, we still haven’t overtaken anyone in the region, we are on par with Bucharest. It is also important to point out that the Big Mac index focuses on cities, and while Budapest is clearly catching up, the country is dropping behind compared to the other EU Member States. And this worsening trend continued during the past seven years just as before.


In 2010 144%, in 2014 143% where 100% means the EU average

Only Budapest is above the EU average, the second best county – Győr-Moson-Sopron stands at only 77%. In the light of the foregoing it is worthwhile showing also how the best performing Hungarian regions – where the situation in this area has worsened since 2010 – compare to our V4 competitors. In 2014 in the same category Prague was stood at 173%, Bratislava 187%, Warsaw 197%. Notably in the case of Budapest, Pest County is also part of the region.

GDP per capita by purchasing power parity, 2015


In 2010 24.5%, in 2015 22%

The more food is produced by local, domestic producers the better, both environmentally and economically. According to a relatively recent Corvinus University study, positive, if modest changes have taken place in this area.

It is so far growing in the second Orbán government period, due in part to last year’s persistently low inflation, the third year in a row, and, on the other hand, partially due to the inflation-indexation of pensions introduced by the Gyurcsány government and which during the Fidesz government was often surpassed through the use of small tricks.


In 2008 the gross benefit was HUF 28,500, in 2016 just as much. In international comparison, this is dramatically low.


In 2009 it was USD 9,500, in 2015 – 9,149.

The biggest change in the area of earnings in the past period, as mentioned before, was the flat personal income tax, which benefitted primarily the affluent. At first glance the above seems even a decrease, but due to the significantly weakened forint exchange rate in the period the balance is rather a positive one. This fact doesn’t make for any exuberant joy because according to the OECD data, admittedly in need of updating, the approx. USD 9,500 earnings (just as a few years ago) was sufficient only for the last place among the EU member countries.


In 2010 – 3 million, in 2016 – 3.6-3.8 million

In addition to this terribly high number, perhaps it is most important to note that after nearly a quarter of a century, in 2011 the CSO stopped publishing any figures about exactly how many people live below the poverty line. (The Policy Agenda think tank, however, has calculated that by 2015 the number has grown to 41.5%. See our article on all of this.)

Actual Individual Consumption in the European Union, 2014

Furthermore, the CSO had calculated that at least 87,351 Ft. monthly net earnings were required (in 2014) for living at a subsistence level. In comparison the net minimum wage in 2016 was still 73,815 Ft. In the first case it seems there was finally a move forward. Thanks to the tenacious struggle of the trade unions in 2018 the minimum wage will reach the subsistence level of around 90,000 Ft. However, thanks to the far higher 35% tax burden, in net terms the minimum wage is still light years behind that of our competitors in the region regarding the increases carried out between 2008 and 2016. In addition, Hungary has the highest proportion (72.2%) across the EU of households that wouldn’t be able to pay any unexpected expense.


In 2009 – 70,971, in 2014 – 66,000

The population has been declining steadily since 2010, but we surely aren’t so many fewer. Actually there are more elderly. Therefore we need more, not fewer beds.


Not only compared to 2010, but in fact never has any government since 1990 spent so little on healthcare, as a percentage of GDP, as in the past several years. And this is not only a basic requirement for a more successful functioning of the economy but also a factor that could have improved significantly the overall mood of the whole country. Recent research has shown that the overall satisfaction level in a country is not best raised by increasing the earnings of the inhabitants but by spending relatively larger amounts on problems of well-being. There is also a demand for it. According to the 2016 European Social Survey the Hungarian society is in a terrible state compared to the other European countries: in Hungary people consume the smallest quantities of fruits and vegetables, Hungarian women are moving the least, compared to the Hungarian men only Lithuanians smoke more, compared to the Hungarian men only more Czechs are overweight, Hungarian women are the most overweight, we have the largest proportion of men in poor or a very poor state of health, compared to the Hungarian women only the Spanish women are in a worse state of health, among the Hungarian men are the most showing signs of depression, and the Hungarian population, both men and women, is most affected by cancer. After that, perhaps it’s not surprising that we visit doctors most frequently among OECD countries.


Similar to the health care case, counting from 1990 we have never spent so little of the GDP in this sector as during the Orbán government. Yet the word education could safely be replaced by “future,” since it is basically influenced by the country’s medium and long-term competitiveness. We are rank penultimate in Europe [in spending], so such investment here would bring the biggest return among the OECD countries. The results are visible: we are sixth from the bottom in the OECD in the number of researchers employed in the country; there haven’t been so few studying in higher education in the last seventeen years. We spent the least for developing computer skills, and our students have the largest number of school hours for non-essential knowledge (e.g., ethics [compulsory alternative to religion], etc.) as opposed to essential ones (e.g. reading, writing, literature, mathematics, natural sciences, second or other language). In view of the above, the recently published PISA results, which understandably caused an outrage, probably represent only the tip of the iceberg.

One of the few positive steps in the past few years is that those who cannot find work are, finally, offered free training, but the training offered by the National [Vocational] Training Register (Országos képzési jegyzék) is unlikely to boost the highest added value production areas. In addition, the participants’ livelihood is not guaranteed during the course; hence the training can only be used by jobseekers with a better financial cushion or those enjoying a patronage. Improving job qualifications is needed to raise our incredibly low average salary, which already inhibits economic growth.


In 2009 – 46th place, in 2015 – 50th place

Even the people in Saudi Arabia, Botswana, Qatar and four-fifths of our region feel their governments are less corrupt.


No previous government has shown less interest in this area. The Orbán government’s response to the day-by-day worsening problem of global warming was to abolish the Environment Ministry and to do nothing about the few concrete promises it made before the election – including the creation of a green bank. In the meantime, they managed to earn the glory of the “tree-felling government” title, since probably no one has cut down so many trees as they have done in the last seven years in Budapest, and they have plans for more. Moreover, we are perhaps the only country in the world to impose taxes on solar panels while indebting Hungary by a loan equal to at least 10% of GDPif not more – for the sake of a twentieth-century technology for [Russian nuclear reactor blocks] Paks 2, which, in the bargain, will surely never produce a return.

Meanwhile, despite all the flag waving and freedom fighting the external exposure of the Hungarian economy has not been reduced at all. And here it is not primarily the foreign currency denominated debt segment that counts most, nor the export-import volume, which reached 200% of GDP, but the fact that less than half of the exported added value is created in Hungary. In other words, more than 50% of the added value produced in Hungary is by foreign-owned companies, which is unique in the European Union. It is no surprise that of the EU money arriving here for business development – after the government has carved off its significant slice – almost 70% is awarded to multinationals.

Such a level of foreign investor influence is extraordinary even by regional standards, although in Eastern Europe we are all rowing in the same boat, i.e. in what the literature calls a dependent market economy. That is, our economies are wholly dependent on Western investments. This is particularly true for the car manufacturing brought to Hungary, because it accounts for more than 20% of Hungarian exports, and this situation hasn’t changed since the year 2000. Meanwhile a leading Fidesz politician says that nothing can be done because “Hungary is a determined country, where it’s impossible to pursue other economic policies.” But it was precisely the Orbán regime which showed that it is. Over the last fifty years countries such as South Korea, Taiwan and Singapore went through economic development with substantial state assistance, which took them to where we are heading today. Big companies like Samsung, LG and Hyundai were heavily subsidized by the state, which in return set certain export expectations, so these companies were forced to continue spending on innovation. While it is a widespread view that the international rules made impossible this type of government intervention, we can see that the Orbán regime can support their oligarchs without any sanctions. The problem is that instead of innovation the regime expects only political loyalty. Despite its references to them as a model, none of the East Asian models’ components has been employed.

In light of the above it is not surprising that there have never been so many who wanted to emigrate from the country. Meanwhile the middle class is eroding and the differences in wealth between the richest and the poorest are increasing.

There is money available though, since up to now the government has spent HUF 300 billion on state companies and a further HUF 100 billion on its own (i.e. our) soccer pet. Overall, we spend four times more on this prime minister’s mania than on road maintenance, while the number of spectators is steadily declining. There are other outlays that went wrong too – the György Matolcsy-led National Bank has had HUF 250 billion pumped into dubious foundations or spent for the purchase of art objects. In addition, another HUF 850 million was sunk into the Felcsút narrow gauge railway, never to produce any return, and HUF 6.7 billion credit was extended to Andy Vajna for the purchase of TV2. Speaking of Andy Vajna, it is worth highlighting the greatest of all items, in regard to which the government didn’t do anything, namely the offshore [knights racket]. Moreover, Hungary is actually moving in this direction. Even in the face of the couple of years old study finding that the almost unfathomable amount of USD 247 billion of untaxed income has left the country in past decades. In the course of this offshore racket we have suffered the second largest losses in Europe.


Looking at the numbers the government could demonstrate quite serious achievements compared to 2010, primarily in the area of balancing the ​​budget and public debt. The GDP growth rate could have been included but for the fact that this growth was due mainly to the accelerated EU investments and not to a better performance of the domestic economy. In fact our productivity has been stagnant since 2008.

On the other hand, the social inequalities have increased dramatically during these seven years. It is unlikely that these short-term favorable macro-economic data can be sustained in the long term, mainly because the Hungarian society’s human capital indicators have significantly deteriorated as a result of the dramatic underfunding of the public subsystems (healthcare, education, social policy, public transport). That is, the economic growth is due to a great extent to the EU investment funds and the short-term budgetary balance to huge austerity measures. Both are unsustainable.

February 19, 2017

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

“Hungarian society is in a wretched state”

Two and a half years ago 444.hu reported on the then newly published “Survey at a Glance,”  a poll taken by the Organization for Economic Cooperation and Development (OECD). The editors summed up their findings on Hungary as “We are unhappy and sick. We are frightened and hate everybody and soon enough we will slip away from the community of developed nations.” After reading the summary of the statistics, I decided that the title, which at first glance seemed overly dramatic, pretty well described the state of affairs in Hungary in 2014.

This time 444.hu looked at the newly released data of the European Social Survey (ESS) in which researchers studied such societal attitudes as trust in justice, views on welfare, understanding and evaluation of democracy, personal and social well-being, health and its determinants, and attitude towards immigration. The general impression was that “Hungarian society is in a wretched [ramaty] state.”

ESS’s findings are based on an enormous amount of data collected by sociologists from over 30 countries. In Hungary the work was done by researchers of the Hungarian Academy of Sciences who a few days ago organized a conference on “Where is Hungary on the map of European Societies?” The 444.hu article is basically a report on the lectures delivered at this conference, but I suggest taking a look at the actual ESS survey, which is full of fascinating details.

It never fails: northern European countries lead the way in practically all categories, be it education or people’s trust in institutions and each other. They are followed by the western half of the continent. Hungary, alongside other East-Central European countries, lags behind. As 444.hu reports, Hungary is near the bottom of the countries studied in almost all categories. Here I will look at a few findings that I personally found revealing.

The first: people’s interest in and knowledge of politics. Respondents were asked to indicate their interest in politics on a four-point scale. The Danes and the Germans were the winners here with a score 2.84, followed by the Swedes, Swiss, Dutch, Finns, Brits, all the way down to Hungary (1.96) and the Czech Republic (1.82). What is the reason for such a low level of interest in politics in Hungary? One might guess that it is their disappointment in the political elite. Disillusionment is certainly part of the problem. The other reason might be the barriers to joining this select group of people entrusted with governing the country. But it turns out that the most important reason is that Hungarians feel inadequate to the task of being engaged in politics. As 444.hu in its usual blunt way put it, “Hungarians are not only not interested in politics but consider themselves too stupid [hűlyék] to pursue it.” Their feeling of incompetence, according to the sociologists, is a greater barrier than the closed nature of politics. Mind you, Hungarians are not entirely off the mark when they have a low opinion of their own competence. In the last 25 years almost nothing has been done to teach schoolchildren about the Hungarian political system.

We often read reports, especially in pro-government papers, about the dreadful no-go zones in those western European countries with a high percentage of African and Middle Eastern immigrants. These reports claim that in Hungary, where there are practically no newly arrived immigrants, public safety is assured. People are not afraid to go out on the street at night. Well, this is simply not so. Nowadays all apartment houses are shut tight. People, not just in Hungary but everywhere in East-Central Europe, are afraid to go out at night even if neither they themselves nor anyone they know has ever been assaulted.

The ESS report’s chapter on “Social Inequalities in Health and Their Determinants” uses a model called the Dahlgren-Whitehead rainbow in which there is a lot of emphasis on individual lifestyle choices: fruit and vegetable consumption, physical activity, smoking, alcohol consumption, BMI, health care utilization, mental well-being, quality of housing, and working conditions. Hungarians are not known for their wise lifestyle choices. Most people would rather opt for medication for, let’s say, high blood pressure than try to lose weight and exercise more. Thus, it is not terribly surprising that the percentage of seriously ill people is very high, nearly 14%. This places Hungary in the penultimate position among 21 countries studied.

Percentage men and women in bad or very bad health

Percentage of men and women in bad or very bad health

Let’s see some of the contributing factors to this sad state of affairs. Here is a country that is justifiably proud of the quality of its fruits and vegetables. Yet Hungarians don’t eat them; Hungary has the lowest fruit and vegetable consumption. Hungarian women exercise the least while the men beat only the Portuguese. Hungarian women are the most overweight, and only Lithuanians smoke more than Hungarian men.

The Hungarian researchers in this particular study didn’t talk about alcoholism, but it is also a serious problem. A few days ago HVG reported on a Hungarian initiative called “Dry November,” a version of “Go Sober for October.” Its organizers complained that the Orbán government not only has no “alcohol strategy” but in fact has been promoting pálinka consumption.

When it comes to political engagement, the current Hungarian government has no reason to encourage widespread civic participation, which would threaten its hegemony in the political sphere. And enlightening schoolchildren about the workings of democracy as we in the West understand it is certainly not to the advantage of the autocratic, semi-dictatorial regime of Viktor Orbán. As for bolstering preventive medicine and campaigning for more healthful living, this would require a great deal more money than the Orbán government currently spends on healthcare. The Orbán government did establish a network of tobacconist shops for the alleged purpose of limiting tobacco use. Their real purpose, however, was to give the faithful a monopoly on tobacco sales.

All in all, one can’t expect any great improvement in the “wretched state” of Hungarian society, which remains full of unhappy, sick, and fearful men and women.

November 20, 2016

Hungarian healthcare: Just one case of many

Today’s post was inspired by an article that appeared about a week ago in Népszabadság. Actually, it was more like a letter to the editor describing a young woman’s frustration with the Hungarian healthcare system. In this short piece of writing (about the length of one of my posts) we encounter an incredibly rude physician, long lines for most likely unnecessary procedures, and broken equipment.

Klára Kovács, the author of the article, is in her thirties. And, as she remarks in her piece, “nowadays for people like myself, in their twenties and thirties, it is taken for granted that we find recipes, music, news, and basic medical information on the internet.” So, by the time she decided that she should visit a doctor because of severe pain behind her left knee, she had a fair idea that she was dealing with a Baker’s cyst, a pocket of fluid that forms a lump behind the knee. A baker’s cyst can be caused either by an injury or by arthritis of the knee. Once the original problem is treated, the cyst may go away on its own. If not, the cyst can be drained or the doctor can prescribe a steroid shot to reduce the swelling. The literature available on the internet also mentions the possibility of ordering an MRI “to see a picture of the inside of your knee.”

It sounds simple. Well, let’s see what happens in Hungary to someone who goes to a doctor with a strong suspicion that she has a Baker’s cyst. First, she called her district clinic, where she was told that they cannot deal with her problem because her cyst can be handled only in a surgical facility. This piece of information turned out to be erroneous, and although the surgeon on duty was pleasant, he wouldn’t treat her. She had to go to the orthopedic department. There she encountered a real brute who accused her of circumventing the system by first getting an appointment with a surgeon, which allowed her to get an immediate appointment with him, instead of going to the general practitioner as is the rule.

The doctor went on and on: “Do you think that everything is permissible around here? You think that we are here to wait on hustlers like yourself? Show me your problem. Stand normally! You can’t even stand right?” He gave her hell for not coming earlier and informed Klára that Baker’s cyst is a symptom and not an illness by itself. Of course, Klára must have known all that without him because the Hungarian website’s explanation is just as thorough as the English-language one. It was also quite sensible of Klára not to rush to see a doctor because these cysts often disappear on their own after some rest and home remedies. He ended his harangue by telling her all sorts of frightening misinformation about her illness. For example, that “it is possible that the cyst will explode and with a little luck together with your whole leg will go.”

The relationship between doctor and patient should be a cooperative affair

The relationship between doctor and patient should be a cooperative effort

In any case, after this terrible scene Klára was sent for an MRI so the doctor could learn more about why the cyst appeared. What surprised me about Klára’s encounter with this doctor is that he asked nothing about her general health and lifestyle. Does she do any sports? Could she have had an injury? Did she have any operation on her knee? (As it turned out, she did.) Does she have signs of arthritis? One could find out a lot without immediately resorting to an MRI. Moreover, by then Klára was in considerable pain. According to her own description, the cyst behind her knee was as large as her whole knee. Why didn’t he drain the cyst in order to relieve the pain, at least temporarily? The Hungarian internet is full of forums of people whose cysts were drained. It is a painless procedure lasting only a few minutes.

Sending Klára to have an MRI meant starting everything from scratch. She had to go back to her general practitioner because, for an MRI, she needed a blood test to ascertain that her kidney function was okay. My first question: Why couldn’t the orthopedist give her a piece of paper which would allow her to have a blood test? My second question: Did Klára really need the blood test? While doing research for this post I learned that for some MRI scans contrast materials have to be injected, which for people with poor kidney function can be dangerous. The likelihood of impaired renal function is substantially higher in patients over 60 years old and/or people who have certain illnesses, such as diabetes. At UCLA older patients are required to have the blood test. Other patients get a questionnaire on the basis of which the doctors can pretty well identify those people who are at risk of having renal problems. They thus avoid ordering blood tests for all patients. But I guess the Hungarian healthcare system is less frugal with both money and the time of doctors and patients than UCLA is.

The second stage of Klára’s battle with the Hungarian healthcare system began with a wait in her GP’s office for an hour and a half to get a piece of paper ordering the blood test. The next day she spent two hours waiting for the blood test itself. She had 67 people ahead of her and only two nurses drawing blood. She got an appointment to have the MRI three days later, which “is considered to be a miracle in Hungary.” As it turned out, however, her praise was premature. When she arrived for her test, she was told that something went wrong with the MRI machine and if she urgently needs to have the procedure done she must try her luck at another hospital at the other end of the city. They couldn’t guarantee that the procedure would definitely be done that day. She was supposed to be there within half an hour, which given the afternoon traffic seemed an impossibility. She therefore asked for another appointment. But they couldn’t accommodate her because all the slots had already been filled for the month. She was advised to phone sometime during the last week of the month when they work on the schedule for the following month.

Luckily for Klára, she didn’t have to make that telephone call. The following day the cyst painlessly erupted. Gone was the pain and the swelling. Contrary to the doctor’s prophecy, her leg didn’t explode. The cyst disappeared without any medical assistance. “It seems that even the cyst didn’t want to have anything to do with this healthcare system,” Klára concluded.

June 14, 2016

Hungary actually spends an enormous amount of money on healthcare. It is just a question of definition

This morning I read a comment by a journalist who announced that it is no longer worth listening to the Friday morning radio interviews with the prime minister because by now the reporter can’t ask any questions, even friendly ones, about the political events of the previous week or fortnight. At the last interview not a word was exchanged about the teachers’ strike, and this time the Hungarian National Bank’s foundations proved to be too insignificant to mention. Nonetheless, I managed to find an exchange at the very end of the interview that I believe merits comment.

Orbán outlined all the positive changes his government has been introducing of late that are making the lives of a large number of Hungarians more economically secure. First, the government raised the salaries of the policemen and soldiers. Then, a year later, they increased the salaries of the teachers, although naturally he neglected to say that for the higher wages the teachers had to work longer hours. The next task will be an improvement in the lot of doctors and nurses. Moreover, the government will find money to raise the salaries of people working in the cultural and social spheres– like librarians and social workers. Everything he promised was or soon will be fulfilled, he added triumphantly.

At this point the reporter chimed in, quoting a statement from the State Audit Office that pointed out “great management shortcomings and public procurement anomalies.” Viktor Orbán interpreted these words to mean that there is not enough money being spent on healthcare. (I guess something must have been lost in translation.) He immediately began talking about the amount of money that is being allocated to healthcare which, as we all know, is much less in Hungary than in other countries in the region. But it seems that Orbán has an entirely different definition of healthcare and, therefore, of the amount of money a country allocates to it. Let me quote the most important part of what he had to say here.

My thinking is a bit broader on that topic than the ideas of health experts. Because the budget of healthcare is not really the budget of healthcare but the budget of healing. I don’t mix up healthcare with healing. These two things overlap somewhat, but one of them is bigger than the other. So, we spend more on our health than the sums allocated to healthcare in the budget because in reality these are sums for healing the sick. Sports, daily gym classes, our investments in infrastructure that are necessary for healthy living all serve our health needs. So, in a more comprehensive way of looking at things, we could easily add these items to the healthcare expenses. We don’t calculate that way in Hungary, but I always like to put the budget together this way.

Well, let’s see what all this means in black and white. It is very difficult to find out exactly how much money is allocated to healthcare—healthcare in the commonly accepted sense, not in Viktor Orbán’s definition—because even economists specializing in healthcare issues can’t quite figure out the final amount for 2017, for example. However, according to Bence Rétvári’s announcement, which must be viewed with extreme caution, the Hungarian government will spend 500 billion forints on healthcare in 2017.

Billions for healthful living

Paragon of healthful living

And figuring out the amount of money spent on sports and infrastructure for football stadiums, swimming pools, sport stadiums of all sorts is even more difficult. However, here are a few figures that might give you some idea of the lavish spending on sports-related items. In two years (2012-2013) the government spent 142.6 billion forints on sports of all sorts. In 2014, they spent 168.6 billion. But direct government spending is only a part of the whole sports package because companies can offer billions of forints for different sports, mostly football, which means that yearly at least 50 billion forints never reaches the central budget. This money goes straight to sports clubs, mostly to the Ferenc Puskás Foundation in Felcsút.

A more recent assessment predicts that tax-free gifts for sports will be about 90 billion forints in 2017. This means that since the introduction of the system, more than 400 billion forints has gone straight to sports clubs instead of to the central budget. In addition to the 90 billion forints in “charitable contributions,” it is projected that the government will spend 223 billion forints next year on sports.  Others estimate government expenditure on sports in 2017 to be as high as 400 billion forints. Thus, we are getting close to the amount of money the government ostensibly spends on “healing the sick,” to use Viktor Orbán’s expression.

These figures do not include the construction and renovation of soccer stadiums. Atlatszo.hu estimates that the seven stadiums that have already been completed cost 42.11 billion forints. And this is just the beginning, a very small beginning. Practically peanuts, because in the next three years 32 new stadiums will be built or renovated to the tune of 215 billion forints. Thus, I estimate that the Orbán government actually spends more on sports than on healthcare. I can say only one thing: “A crime against the Hungarian people!”

May 6, 2016

Hungarian healthcare in the grip of a corrupt medical aristocracy

A revelatory opinion piece appeared in today’s Index, written by Gabriella Lantos, managing director of the Róbert Károly Private Clinic, which specializes in women’s medicine. Lantos lays out in a convincing way “what is wrong with Hungarian healthcare.” Of course it is a complex issue, but the main reason for the close to hopeless situation of Hungarian healthcare is the hold of a corrupt medical aristocracy (orvosbárók), the top few thousand of the 30,000 practicing physicians in Hungary. Gabriella Lantos, who is safely ensconced in a private hospital, felt free to sign her name, unlike the author of an opinion piece on the same subject that appeared in HVG back in 2012 who remained anonymous, fearing consequences. Interestingly enough, the author of that article also talked about the corrupt medical aristocracy as the source of the problem. He also described them as “orvosbárók” who rule hospitals like personal fiefdoms.

The common wisdom in Hungary is that there are not enough doctors because about 10,000, mostly young doctors have left the country for British, Swedish, German, and Austrian hospitals. Even twenty years ago when there were about 44,000 doctors in Hungary one could hear the same complaint. At that time I countered that there was an overabundance of physicians in comparison to wealthier western countries. That is still the case. There are fewer doctors in the United States per 1,000 inhabitants than in Hungary (2.6 versus 3.3). A couple of months ago I heard Péter Mihályi, a professor of economics specializing in healthcare issues, give a talk in which he claimed, just as Gabriella Lantos does in this article, that there are enough doctors in Hungary. The mostly liberal audience was up in arms. They simply refused to believe it.

It is unnecessary to bemoan yet again the abysmally low pay of both doctors and nurses, which is not enough to keep body and soul together. But Lantos’s description of ways a doctor can make extra money is educational. First, and most obviously, after his shift is finished the doctor can sell his services to the hospital as an entrepreneur for the market price of 5,000-6,000 forints per hour instead of the 1,200-1,800 ft. he gets as a state employee during regular hours. In some provincial hospitals one can get even 8,000-10,000 per hour or 50,000 for a day.

Another way for a doctor to boost his income is to join a private practice. There are at least two dozen private clinics and practices in Hungary, mostly in Budapest. There, depending on his expertise, a physician can easily make 5,000-20,000 forints an hour, or he may work for a decent commission. These private hospitals and practices do a brisk business. According to Forbes, their turnover is about 80 billion forints per annum.

Finally, there is the gratuity system (hálapénz) which, according to estimates, amounts to 70 billion non-taxable forints in the pockets of certain doctors. At the top of the “gratuity pyramid” are the hospital directors, heads of departments, and star physicians. About 20% of all doctors are in this category, and they receive 80% of the “tips.” That is about 50 billion forints, which breaks down to a monthly non-taxed income of 1-8 million forints a month. The other 80% of the doctors have to share the remaining 20 billion forints, amounting to about 1-2 million forints per year. According to Lantos, these “physician barons make three times more than their colleagues in western Europe, where the average salary is 25 million forints after taxes and social security payments.”


Illustration: Szarvas / Index

So, if there are enough doctors, why do people believe there is a shortage? One reason is that there are not enough nurses in the system, so doctors perform tasks that in other countries are done by nurses and physician’s assistants. The reason for the shortage of nurses is the incredibly low pay. The average pay is no more than what a cleaning lady makes elsewhere (100,000-130,000 forints or €420). Highly qualified surgical nurses with years of experience make only 170,000-200,000 forints, or about €640 a month, while the average salary of a nurse in western Europe is €2,500.

Another reason for the seeming shortage of physicians is the incredible number of hospitals and hospital beds. Let’s start with the beds. In Hungary there are 7.1 hospital beds for every 1,000 inhabitants as opposed to the United States and the United Kingdom where that number is under 3.0. Because of the way government payments for healthcare services are structured, a longer hospital stay, whether the patient needs it or not, benefits the hospital. Therefore once a person finds himself in a hospital bed he will not be released for over five days. In the United States 64% of all surgical procedures are done on an outpatient basis; in Great Britain and the Scandinavian countries 50% are. In Hungary only 8% of procedures are done that way.

Apparently, many Hungarian doctors are qualified to use the more modern procedures that don’t require protracted hospital stays. Some are already using such procedures when working abroad. But they cannot replicate them in Hungary because hospitals would go bankrupt without the longer hospital stays. Administrators who code medical procedures for government reimbursement use every trick in the book to make them seem as complicated as possible to milk as much as they can from the government. There is also an interesting twist to this story. If the head of the department uses old-fashioned methods, his younger subordinates cannot use more modern procedures. It’s no wonder that young doctors leave in droves to go abroad.

There is another reason that the medical establishment prefers the older surgical procedures. As Gabriella Lantos puts it: “The longer the scar and the longer the time for recuperation the higher the amount of the gratuity. If someone after an endoscopic procedure with a half-centimeter scar can go home the next day, he most likely will not pay 150,000-300,000 forints to the surgeon.”

Finally, moving on to the number of hospitals. Believe it or not, Hungary has 160 hospitals, if you can call them that. According to healthcare experts, one well-appointed hospital nowadays can serve one million people. So, Hungary would need 10 “real” hospitals, as Lantos puts it, with 5,000 beds each. If that is too radical given Hungarian circumstances, Lantos offers a compromise of 25 hospitals with 2,000-3,000 beds.

Apparently the Hungarian definition of a hospital at the beginning of the twentieth century was a building that could accommodate at least 100 persons in wards with 12 beds each. Today that definition has been whittled away. Of the 160 Hungarian hospitals 90 have at least 80 beds while the rest, that is 70 of them, look after even fewer patients. Yet these facilities are not only called hospitals but their financing is based on their being full-fledged hospitals.

According to another definition, a city hospital must have at least four departments: internal medicine, surgery, obstetrics, and pediatrics. Only 62 hospitals have a department of obstetrics, and  in 24 of these fewer than 700 babies are born a year, that is fewer than two babies a day. These medical institutions should, Lantos argues, be closed. They are neither medically safe nor economical. The institutions that remain (about 35) are real hospitals and as such deserve modernization and investment in improvements.

Yesterday I reported on the incredible popularity of Mária Sándor, the nurse in black. When this modern Joan of Arc began her crusade, she struck me as naïve. She was hoping to get help from Viktor Orbán and Fidesz politicians in parliament because she was convinced that they simply don’t understand what’s going on in Hungarian hospitals. After a few months, disillusioned and disappointed as well in the trade unions that are supposed to represent her and her colleagues, she has become bolder and a great deal less charitable. She now talks freely about the incredible corruption of the top echelon of the medical hierarchy and even made a fleeting remark about the kickbacks these hospital directors and the top doctors receive from companies providing essential supplies to the medical facilities. She made no bones about her contempt for these people. She is convinced that as long as they are in charge nothing will ever change.

The anonymous article from 2012 I mentioned at the beginning of this post bore the title “Members of the medical aristocracy must be convinced.” To convince in Hungarian is “meggyőzni.” My first thought was that “convince” was the wrong verb. Instead of “meggyőzni” one should use “legyőzni,” which means “to defeat.”

April 18, 2016

Is Viktor Orbán’s edifice starting to crumble?

I know many people in Hungary and elsewhere are certain that Viktor Orbán is a political wizard who always wins. I concede that he is a skillful political strategist, but it is simply not true that all of his political moves have met with success. A year and a half ago he didn’t win when he had to scrap his ill-conceived internet tax. In 2002 he lost the election, due primarily to his inability to govern the country effectively. And it didn’t matter how viciously he attacked the Gyurcsány government and Gyurcsány personally, he lost the election again four years later.

Admittedly, the situation is different today. Orbán is running the show, and he has done everything in his power to guarantee that he can remain prime minister of Hungary (or perhaps, later on, president) until his last breath. Yes, everything is stacked against the democratic opposition, which is weak and fragmented. But there are times when a structure can collapse without much help from the outside. The beams give out and the roof falls in because the whole structure is rotten.


Something like that is happening today in Hungary, but I don’t think that Viktor Orbán realizes the gravity of the situation.

Let’s start with Medián’s latest poll, which shows that, for the first time since August-September 2015, Fidesz lost a substantial amount of support last month. After the fence went up in September 2015 Fidesz’s popularity soared. And it stayed high throughout late 2015 and into January of 2016. In February, however, it dropped. The change was especially large among the “active voters,” i.e. those who faithfully cast their votes at every election. In this category Fidesz’s 53% dropped to 46% within a single month. And what may be even more worrisome for the government party is that those who think that Hungary is heading in the wrong direction grew from 54% to 60%. Moreover, every tenth person who remembers voting for Fidesz in 2014 now says that there is no way he/she would vote for the party again.

As I emphasized in my post on his speech to the faithful the other day, Viktor Orbán went “all-in” on a single hand: fierce attacks on the European Union for its refugee policy. These verbal assaults have been intensifying, to the point that a growing number of people fear that Viktor Orbán’s real goal is to leave the Union altogether. Turning against the European Union, however, is probably a dead end. Seventy-three percent of the population support Hungary’s EU membership. EU bashing will not quell the rising domestic unrest.

On the education front the government is getting nowhere. László Palkovics, undersecretary in charge of education, keeps inviting organizations representing the disaffected to the roundtable, but one after the other refuses to participate in a process they consider to be a charade. By now the government even appears to be ready to give up KLIK, the giant state employer of 140,000 teachers and other school workers, which was supposed to be sacrosanct only a few days ago. Zoltán Balog is also prepared to allow 10% autonomy, even in matters of curriculum. But nothing doing. Those who started the movement for fundamental change in education are not ready to negotiate with the authorities because they don’t trust the government.

The government and Viktor Orbán personally are being viewed as cowardly because they are so afraid of a referendum on the issue of Sunday store closings that they sent skinheads to physically prevent István Nyakó (MSZP) from turning in his referendum question. Even Fidesz bigwigs consider what happened in the building of the National Election Office a dangerous precedent and a disgrace. The husband of the woman whose nonsensical referendum question, with the help of those 200 kg football hooligans, was accepted is in some trouble. He is the mayor of Herceghalom, and the members of the town council, including Fidesz members, are demanding his resignation. If he doesn’t leave on his own, he will be recalled.

Then there are the problems at the Museum of Fine Arts, one of which involves lending five or six baroque paintings for practically peanuts to friends of the mysterious Árpád Habony. Átlátszó asked the museum to provide a list of all the artwork currently out on loan. The museum director, a Fidesz favorite, instead of quietly obliging, demanded 600,000 forints for the list. When Átlátszó complained, they were told that 450,000 would do. At this point someone from above must have told the politically insensitive museum director to cease and desist. Suddenly, Átlátszó could receive the list free of charge.

The Fidesz-majority Hungarian parliament wanted to restrict access to public information about the state-owned postal services as well as businesses and foundations established by the National Bank. Attila Péterfalvi, head of the National Authority for Data Protection and Freedom of Information, whose past judgments didn’t go against the Fidesz government, rejected Fidesz’s attempt to justify the constraints by claiming that public funds given by the central bank to its foundations “lose their public nature.” This morning Magyar Nemzet learned that János Áder might refuse to sign this disgraceful piece of legislation. I’m almost certain that Magyar Nemzet’s information is correct, especially since László Kövér announced a few hours ago that the Hungarian National Bank’s money is public money. Period.

Finally, another piece of news from today. Until now the government refused to admit that anything is wrong with Hungarian healthcare. The usual mantra has been that all of the hospitals outside of Budapest are in great shape. The capital needs a new hospital, as Orbán said in his speech, but it will be built by his government soon. Well, today one of the assistant undersecretaries in charge of healthcare policy in the ministry of human resources admitted that there is a shortage of physicians. He openly talked about the crisis that has developed in the sector. “It doesn’t matter what we do when there aren’t and there won’t be enough doctors to keep up the present healthcare structure.” The only solution, he said, is to produce as soon as possible a number of “physician assistants” who can take care of some of the less serious cases. The number of doctors and nurses leaving the country is alarming. A very large raise in salaries, he suggested, could slow down the process.

In brief, the structure Viktor Orbán built is falling apart at the seams. But what is Viktor Orbán’s response? He is building a new stadium. This time a 800-seat stadium in Kozármislény, a small town in Baranya. At least this one will be relatively inexpensive, only 440 million forints. Since 2014 the Orbán government has spent a staggering 225.5 billion forints on stadiums. It’s no wonder that people are fed up and are no longer so afraid to stand up and be counted. There will be a breaking point, and it may be sooner than we think.

The mood of the country is changing. Here is a good example of what I mean. Yesterday a very critical article was published by Mandiner, a conservative internet site, on György Matolcsy’s attempt to “privatize” public funds by hiding them in foundations established by the Hungarian National Bank. The articles that appear on Mandiner are not as extreme as those in Magyar Idők or Magyar Hírlap, but the comments consistently show a right-wing, pro-government bias. This time, however, almost all of the readers agreed with the author and were highly critical of Matolcsy. Something has changed. Something fundamental, which will be difficult to contain.

March 2, 2016