The following is the editorial from the November 13 biweekly edition of the Budapest Business Journal.
When communism ended, Hungary’s new government inherited a broken health service. The health insurance that taxpayers contributed was not enough to support the system, and the official pay of a doctor was roughly equal to that of a bus driver. It was common at the time to tip doctors and nurses – an acknowledgement that they were underpaid and an incentive for them to give the kind of decent, attentive care that every patient wants.
Roughly 25 years later, the position of doctors and nurses, the custom of tipping and the state of medical care has not changed very much. What is different is that, thanks to European Union membership in 2004, doctors can easily leave Hungary – and they have been doing so at a rate of approximately 1,000 a year for some time now.
Past efforts to help defray the cost of medicine have included a “visit fee” of HUF 300, to be paid by each patient on visiting the doctor, a plan initiated under the Socialist government that preceded this one. Because Fidesz was so indignant at the idea of anyone paying for medical care in Hungary, they stopped the visit fee when they came to power in 2010. But Fidesz has not come up with an alternative. In fact it has shown how little it cares about the issue by putting a state secretary, instead of a full minister, in charge of health care.
Of course, a fee of HUF 300 per visit is not going to solve the whole problem – not when you consider the real costs of doctors’ and nurses’ time, as well as the cost of medical equipment and facilities. Paying for quality health care is very expensive, and no government seems to be ready to tell Hungarians that they have to pick up the bill. But Hungarians, apparently, do not need to be told: They have unilaterally decided to start paying for care themselves, taking out private insurance and going to private clinics.
It seems the market is giving the government a break, as people are figuring out their own solutions. But the government needs to give the market a break, to make it easier to help everyone get the care they need.
For example, a recent program at the Uzsoki Hospital in Budapest’s District XIV sought to mix public and private payment systems by allowing patients to pay extra for additional services, like not having to wait several months for their operation to be scheduled. Again, the Fidesz government expressed the sentiment that no one should have to pay for public health services, and the program was killed.
Instead of seeking to stop creative solutions, the government needs to do more to encourage private initiatives that can help pay for health care. Meanwhile, the electorate needs to understand that meaningful health reform will cost a lot, and that any politician who promises otherwise is not being honest. If we don’t do the hard work of reforming health care, the system will stay the way it is. And it is not clear that Hungarian health care, or Hungarians, can survive this way for another 25 years.