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.