Who doesn’t remember the infamous story of the referendum of March 2008 proposed by Fidesz that was approved by the Constitutional Court in October 2007? The questions were formulated in such a way that only a fool would answer “yes.” Like: “Do you want to pay 300 forints (then $1.50) when visiting a doctor?” Of course, most people answered “no.” Not surprisingly, the referendum was a colossal defeat for the Gyurcsány government and a great triumph for Fidesz. And all this over a 300 forint co-pay when patients regularly put thousands into the pockets of attending physicians.
Just as Fidesz changed its mind on charging tuition in institutions of higher learning, it also changed its mind on allowing hospitals to charge extra under certain circumstances. For example, for an additional fee the patient now has the privilege of choosing his own doctor. And today almost all hospitals offer “luxury” rooms for those who are willing to pay for them. These luxury rooms, by the way, are the norm in hospitals in most western European countries and in North America. They are simply single or double rooms that they have their own bathrooms. In certain hospitals you can even order food à la carte. There is at least one hospital in Budapest where 25% of the rooms fall into the “luxury” category. Initially the management wasn’t sure whether the investment would pay for itself, but it turned out to be a great success. More and more people are willing to pay extra for better hospital accommodations.
A few days ago Népszabadság reported on a new phenomenon. As of a few weeks ago, patients at the Uzsoki Street Hospital can pay not just for extra “luxury” rooms but also for their entire medical procedure. Half of that money will go to the doctors, surgical support staff, nurses, and physical therapists. The members of the support staff work with these private patients as independent contractors. Their work in the private section of the hospital is carefully separated from their activities as employees of the hospital. Or at least this is what we hear from management.
What are the benefits of this arrangement for the patients? First of all, there are no endless waiting lists. I don’t always understand the ins and outs of the Hungarian healthcare system. For me, one of the mysteries of the system is that hospitals can perform only a limited number of procedures even if they have the capacity, in terms of both personnel and equipment, for more. Thus, their capacity is not fully utilized. I assume that the Hungarian healthcare strategists have an explanation for this odd practice, and perhaps it is my fault that I can’t grasp its true goal. But one thing is sure. As a result, in some hospitals one has to wait two or three years for certain procedures. The waiting lists are especially long for knee and hip replacements. If, however, you are ready to pay 1.2-1.7 million forints (approximately 5,000 euros) you can have your operation, and the physical therapy that follows the procedure, within a couple of weeks. These private patients, by the way, forfeit their right to health insurance when they sign the contract with the hospital.
It seems that this arrangement is not yet available in most of the hospitals in provincial cities. There hospital administrators claim that they have neither the extra personnel nor the funds to provide care for both paying and nonpaying patients. In brief, patients in Budapest can receive more timely care than those outside of the capital. I try to explain to my Budapest friends how bad the situation is in the provincial hospitals. A few weeks ago one of my relatives (and he himself was a doctor) had an operation in Pécs and had to wait five solid weeks for the biopsy result. The tumor turned out to be benign, but imagine worrying yourself sick for such a long time over whether you have cancer or not.
Other Budapest hospital administrators would be only too happy to follow the example of the Uzsoki Street Hospital. They think that it is time to speak “honestly” about the problems of the healthcare system that no longer can provide the same high-quality care to all insured patients.
Right now the situation is totally chaotic. According to Népszabadság, in a Budapest hospital the doctors performed a pulmonary biopsy on a patient using a local instead of general anesthesia because the poor man didn’t have the extra money the hospital demands to put a patient completely under. Apparently, the man went through incredible agony. The same anesthesia rule holds true for colonoscopies. The very idea sends shivers down my spine. The price for general anesthsia is 35,000 forints for the first thirty minutes. Only a little over 100 euros, yet in Hungary even this amount is too high for many patients. Moreover, the pulmonary biopsy patient rightly pointed out that he was never told when he was paying his health insurance that certain procedures would be performed only for cold hard cash.
I don’t know how long the Orbán government can postpone a thorough reform of the entire healthcare system.
I just would like to put it in the record that Uzsoki has this system over a year now! It is very clear that Orban and his Fidesz friends want fast, and better treatment form what they can offer to regular Hungarians. The only way to justify the special treatment is providing two-tier healthcare system. Unfortunately this will go against the treatment of ordinary patients.
Unfortunately this step will only strengthen the Jobbik.
I know the answer: forever.
This is democracy. People voted for Fidesz and thereby for this kind of health care. Simple as that. People always accepted differences between people, this is reality and so this is natural. No problem with that– until those who can pay for those ‘extra services’ are similar-looking ‘Hungarians’, and not blacks, gipsies, jews etc.
There is Bangladeshi-level health care for the average people and those who have the money can have somewhere below the average Western health care, but at least something bearable.
But I know many people who have been complaining about the health care (they underwent similar situations) but who proudly voted against the 300 ft co-payment and all the hospital “privatizations” by the bloody communists. They still vote Fidesz. And they are OK with the system as it is, a little complaining is natural (even they think so). The rich people, just like their kids go to Western Europe, go to Western Europe if they need something important.
And this outcome is similar to the university tuition fee problem. The small amount of free places at universities are occupied by middle class kids from solid backgrounds who went to great highschools, poorer kids – if they go to university at all – pay for the tuition and get indebted. In other words, those with more money to begin with enjoy more from the state services and enjoy a better outcome.
But people are not lefty egalitarians. That was a misguided dream of the socialists. They don’t care about differences until the rich people are not “the other”.
(By the way, with reference to Thomas Piketty’s recent book about inequality, I read somewhere that only 5% of Americans think of inequality as a pressing issue, when already the inequality is bigger than in Brazil now, people just don’t care).
But these are too sophisticated arguments, nobody gets those. Fidesz caters to the demand. Fideszniks know how average people think and calibrate their message to them carefully. The sophisticated lefty messages go nowhere. The lefties naively though that people could be persuaded to decide on policy issues. People never decide on policy issues: the 300 forint co-payment referendum was pure hatred and protest. That can get people worked up, not policy issues.
Also, note that this is what is in line with the wishes of the doctors. A lefty government just cannot go against them as most of them are Fidesz/Jobbik leaning. But Fidesz can tame them easily. Co-payment would have meant (or so the doctors feared) no hálapénz (ie. off the books cash to the doctors as a kind of gratitude-money, but often just an default expected pay) to the doctors, while their salaries would have remained the same. Not good. Now this is a legal way to have a higher salary, but mind you for a hálapénz like HUF 200,000 you can get your knee operated earlier, though perhaps you don’t stay in a double room, that option, ie. to game the state system, remains intact.
A 300HUF co-pay? Seriously!!! All that is…. is an irritant that wasn’t going to solve anything. I’d even bet that it would cost more than 300HUF to collect the 300HUF. Forget that, what about the extra lines and time to make the co-pay… Meanwhile people even today firmly believe the *only* way to get any semblance of care is to offer gifts to staff and doctors. In fact most are happy to pay extra to be in a room that has fewer than 8 beds in it if they can scratch up the fee.
Lets face it, the hospitals were in shambles before Fidesz took over. Most hospitals are older run down facilities with out-dated equipment unless you happen to be attached to a University and even then… The lines to get treatment were long as it was and now patients face limits on the number of procedures that can be performed each month in an effort to control costs even further. Along side this mess comes a very reasonable 2nd (for the upper middle class) and 3rd (for the wealthier) tier private system where for about the rate of a co-pay in the US you can get the best doctors, most with internationally recognized credentials, with the good modern equipment in the best facilities in Budapest. Some of these clinics are co-located inside hospitals and they are the *only* normally staffed, equipped and maintained part of the hospital. Yes, good care is abundant but mostly only in Budapest as they are no where near as developed in the eastern part of the country. “Private” clinics outside of Budapest tend to mirror the conditions in the local hospital.
LwiiH: such co-payment exists in many countries and for a reason.
You tend to forget that the co-payment was only but one issue of the many the government wanted to introduce to make the health care fairer and more efficient, but obviously it was the most ‘outrageous’ on which people can obsess (as you do).
From personal experience I can tell you that the payment was very seamless, I paid it at least a dozen times without a problem in various institutions. Even today in better managed places you have to register yourself at a registration desk (there is usually no line), and with that effort, you also paid the fee, it was an extra 30 seconds.
It was an irritant to but most importantly it was an existential threat to the doctors, especially to family doctors, where often the service is short, so people would have avoided paying the ‘normal fee’. The co-payment was an irritant that showed in addition that the doctors could not do anything on the state-owned (taxpayer-owned) premises. But the doctors are influential and the left was amateurish as usual.
People may be happy to pay the tax-free extra money to the doctors, I don’t know, but that is certainly not a fair system in any sense of the word.
However, it is deeply entrenched and people do not care about it really, so it stays. Obamacare was also an extremely hard-fought Reförmchen, as the interests are just too big. It was the same in Hungary and the left, as usual, lost.
The co-payment had one immediate advantage. It discouraged unnecessary visits to GPs by “lonely” people that prevents access for the genuinely needy.. Doctor visits dropped 25% after the visit fee was introduced.
I asked this question back in April. Does this two tire system would mean that people can choose between giving their gratuity directly to the doctors or pay the hospital?
Honestly healthcare was not free in Hungary for a long time. I think Orban simply wants to put in the “national cash registers” so he can tax the income. I think slowly they will force everyone to pay for healthcare in the official way. He killed Gyurcsany’s plan because that is what Orban does, kills other’s ideas then perfects them, and sells them as his own. I am sure the same people who were attacking Gyurcsany at the time will be first in line to protect “Orban’s idea” this time. With this idea, Orban will provide “raise” to the doctors without touching the government coffins, make “gratuity” legal, make extra money.
It is like the Hungarian folk tale about King Matthias and the daughter of the judge. The girl came and did not, brought a present and did not, was naked and was not.
“I don’t know how long the Orbán government can postpone a thorough reform of the entire healthcare system.”
Answer: Until the private pension money runs out. Which means, now.
@Margit, obsess as I do? i’m not sure what you mean by that but I’ve dealt with health care systems in a number of different countries and I’m constantly amazed at how how this one able to function given how underfunded it is. The competency level of staff is all over the map. Most of them are underpaid and don’t really care. That is on top of the normal malaise one can see in any medical system any where. When I worked in a hospital we called the “sore toe syndrome”. Incredibly clever creative people often faced dealing with the same problem over and over.. demotivating.. add in lack of equipment, poor facilities and… One thing I could say is that many of the hospitals would be out of business were the to face the same propensity for litigation that the American system is subject to.
@Seagull, I don’t know where you’re coming from but as for copay discouraging people from visiting doctors. I guess it might but I’d have to be really really really exceptionally lonely to sit in a hospital clinic in Hungary just to have some company. These places are old, run down, dirty, smelly, over crowded really unpleasant places to visit. Certainly 300ft isn’t the main reasons to not go to a hospital and I doubt that the reduced visits it due to lonely people making appointments. More than likely some people who were on the fence about a visit changed their mind because of a significant co-pay.
Do I wish health care was better in Hungary, absolutely! It’s being paid for in the tax bill. Unfortunately you can’t hold governments accountable for mis-management of budgets, especially governments in this country. The reality here is, it’s a step back, way back into the previous century and if you want 20th to 21st century health care you’re going to have to foot the bill on your on.
To be honest, I personally welcome this two tier system. I’m fortunate enough to be able to pay a bit of extra money (stress on ‘a bit of’) which would result in better treatment, more humane conditions…etc. I couldn’t fork out 5000 euros for an operation, but if need be I could and would pay extra money to jump the queue in case of an MR or CT examination. A couple of months ago I needed an untrasound. Guess what, the nearest appointment was 5 weeks later. To hell with it, I thought and checked in in an untrasound cinic – for the next day. It cost me 10000 Ft, so it was definitely worth it. But the majority of Hungarian people can’t even pay this much. They put people with tumors on months long lists. I don’t think anyone can imagine the state Hugarian health care is in, until they personally experience being laid up in hospital.
At the beginning of this year I gained a painful insight into the workings of this system. As a result we lost an elderly relative. we had to watch from the sideline how the poor old lady was knocked around in the system as a puppet. And the worst thing was, we couldn’t make it the least bit easier for her. Not even with money. That was the most painful realization. This system is so dysfunctional, that in certain cases even a decent sum of money can’t make a difference. What kind of money could have made a difference, we wondered afterwards and decided, a meagre couple of 100.000 Ft were money down the drain. If we had millions at our disposal, we could have taken her out of state health care, employed pivate practitioners…etc. She may have survived.
This is the Balkan, I tell you. My greatest fear is to fall ill and to have to go to hospital. You really have no idea about the way nurses speak to the patients, the level of arrogance of doctors while they are examining you, the humiliation one has to experience every step of the way. Those who can’t fight for themselves, the meek ones, the poor and the weak, they are treated like dirt. I understand that nurses are severely underpaid, but when they chose this profession they had been aware, hadn’t they. Most of the nurses are so void of compassions I wouldn’t even let them look after my dog. Okay, enought of this. I just had to have it out of my system. Don’t fall ill in Hungary unless you have a big wad of cash in your pocket. 😦
May 4, 2014 at 12:15 pm Quote
To be honest, I personally welcome this two tier system. I’m fortunate enough to be able to pay a bit of extra money (stress on ‘a bit of’) which would result in better treatment, more humane conditions…etc.
So does Orban, his family and friends…
i want you to know that I understand where you coming from, and my family in Hungary also is at the mercy at the Hungarian Healhcare. The problem is that the extra money for hospitals and doctors is nothing new in Hungary, so people will just brush aside this new attack on basic rights on equality. It is not that Orban reforms the current broken, immoral “gratitude system”, bur he came up with a scheme on how to legalize it!
The interesting part will be when finally people figure out that they can jump the cue by paying for the fast track service instead of paying gratitude. There will be a waiting list on the no gratitude, fast track system, hence they will have to pay gratitude money to fast track the fast tracked system.
In part, this makes explicit what has long been an actual two-tier system. In some cases, this has worked well, for example the MAV hospital opening a modern private maternity ward which has helped to offset the costs elsewhere in the hospital for its legacy patients (this is made clear by the way to the maternity ward and its single rooms being through the aging urology ward, with dozens of patients in rooms. Those urology patients, mostly older retired male MAV workers no longer make contributions to the cost of the system, so the cash revenue from the handful of foreign and wealthy private maternity patients is very helpful.) However, the new system, by explicitly signing away patients from the social medical system, bears a real risk should complications ensue. Who pays then? This is far from clear.
“Most of the nurses are so void of compassions I wouldn’t even let them look after my dog”
As a side note, we have been delighted at the level of care and compassion that our various dogs have received from the true medical professionals in Hungary, the ones working in the veterinarian profession. With regards those looking after the human species… well, as one of the resident Fidesz apologists said earlier, since a large amount of medical *professionals* are of the Fidesz/Jobbik persuasion… what do you expect, compassion? humanity? professionalism?
After reading so many stories on how bad the health system is here in Hungary I should add from my own experience that there are many qualified and friendly professionals that I’ve been treated by!
On the other hand I’ve seen and heard real horror stories from friends and family too.
They also are generally very friendly and competent – and their services are of course much cheaper than in Germany so we get our dog his injections etc here in the village or in Hévíz.
PS and OT:
Everybody should download and read Steve Colman’s book to find out about the real Hungary of WW2!
1. Medical personal payments are too low
2. GIving money to doctors and nurses to upgrade the service is no considered corruption in hungarian society but a necessity
3. Waiting lists are being shortened by appearing at the private practice of the same doctor
4. Hospital management is political nomination not professional
5. most of the suppliers of hospital are private companies being chosen by the same politically nominated people
6. Budgeting, priorities are subjected to the level of connection with the ministry, there is no long term plan
7. A single insurance national program financing itself from the taxes leading to lack of motivation to improve
8. Patients are the last priority in the system
9. No private alternatives for surgical professions (except 1 day surgery)
10. Medical standards of care can catastrophically vary between institutes.
11. Medical guidelines are based on ambiguous sources (e.g. Thrombophylaxis)
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